“I decided to have my first caesarean to avoid the pain of childbirth, the possible episiotomy, the future effects of having problems with incontinence and the effects on my sex life. You hear a lot from doctors about caesareans having less risk,” says Tiffany Duarte, pregnant and ready for another caesarean.
After two previous caesareans, her doctor advised her that it would not be possible to have a vaginal birth even if she wanted one — not that she does. “I don’t see any negatives. I quite like them,” she says.
The rate of caesarean sections in Australia has risen from 20 per cent to 29.4 per cent in the last 10 years. Some obstetricians and natal support groups believe this may be due to misinformation and confusion concerning caesareans. Other reasons are that research has found caesareans to be safer for women in certain conditions, whereas others believe the increase is due to women, like Tiffany, requesting caesareans for non-medical reasons. Some have even accused obstetricians of having ulterior personal motives for performing them.
In response to this rate increase, the New South Wales government last year issued a policy directive stating doctors must provide women with all the necessary information regarding caesarean sections.
The lack of accurate information about the risks and benefits of caesarean sections is something the Caesarean Awareness Network Australia (CANA) has been trying to combat for years.
“Women who choose it are not always fully informed about it. We have lots of people contact CANA to say that before they chose their caesarean, they didn’t know the implications of it,” says Philippa Scott, media spokesperson for CANA.
However, Dr Andrew Child, Head of Obstetrics at the Royal Prince Alfred Hospital, Sydney, sees the risks as black and white.
“There are short-term and long-term risks,” says Dr Child. “In the short term, it’s significantly more common to need a blood transfusion with a caesarean than with a vaginal birth. The big danger is a pulmonary embolism, which is when clots go to the lungs, usually within the first two weeks of the caesar; that can be fatal. Post-operative infection in the wound is a risk.
“Then there are the long-term risks and these are becoming more and more of a worry for someone having a subsequent caesarean. The placenta could implant in the wrong place and the uterus could burst. There are quite serious complications. They’re only rare but they do happen.”
Despite the many risks of caesarean sections, Dr Child insists that they are getting safer and are, for some women, a good option.
“A hundred years ago anyone who had a caesar died; it was that sort of level. We’ve certainly decreased the risks. We give everyone antibiotics because that was proven to be beneficial and prevent wound infection. We put special compression stockings on everyone to try and prevent clots forming. So there’s a lot you can do to decrease those complications. It’s getting safer and safer.”
Although many women suffer for long recovery periods after a caesarean, many other women don’t.
“I’ve always found the recovery for caesareans easy. I was in bed for a day and up the next day. I was back to doing full exercise within six weeks. I was lucky both times to have no side effects,” Tiffany says.
Only 1 percent of births in Australia are carried out through “on demand” caesareans. Considering this is only a small amount, it leaves us to question why the overall rate has risen so sharply.
Dr Child believes that there are valid, medical reasons for this rise in caesarean rates. “Studies have shown it’s more dangerous to be born vaginally as a breech baby that it is by caesarean. There’s even a study going on now about twins being delivered by caesarean section. That’s the reason for the increase.”
CANA agrees that this is the reason for the rise in caesarean rates, but believes such medical situations don’t always warrant a caesarean section.
Obstetricians have been accused of coercing women into having caesareans to allow them to work more regular, nine-to-five type hours.
Dr Chid says “Just because you’ve done a caesar doesn’t mean you can go home and get drunk. The patient may have complications that night or have some bleeding; you’re still on call, so it doesn’t make an enormous difference to your work hours to do caesarean sections.”
Included in the policy directive is a controversial short clause stating that women can not have caesareans at public hospitals without a medical reason.
“If I were told I couldn’t have a caesarean without a medical reason, I’d feel very angry. It’s supposed to be a free country and choice is a part of the way we live in Australia. Taking that away from a woman is very depriving of her rights,” says Tiffany.
Dr Kerreen Reiger, Associate Professor of Social Sciences at La Trobe University, disagrees. “The policy seems perfectly sensible. I think choice is a really problematic concept. If people live together in society, there are always constraints on so-called choices. “
The increase in caesarean rates is something that is occurring around the world. Brazil has the highest rate at 56.65 percent and an “on demand” rate of 32 per cent.
“Some women have a caesarean to preserve the condition of the vagina,” Dr Child says. “That’s terribly common in Brazil and Chile. They’ve got extremely high figures in Brazil and some other South American countries. The term they use is that some mothers want to keep the vagina ‘honeymoon fresh’. It’s got some validity in it. There’s not doubt that a vaginal birth stretches a lot of the vaginal tissues and sometimes leaves some quite tender scar tissues where there’s had to be some stitches.”
Dr Kerreen Reiger thinks this belief is misguided. “I think what they’re missing out on is the actual physiological knowledge about what happens to your body in the birth process. A lot of women have a much better sexual capacity after they’ve given birth than they did before. That was true for me and it doesn’t get talked about. It’s a very taboo subject. It needs to be talked about a lot more thoroughly.”