Caesareans
and Your Future Reproductive Health
by: Claudia E. Villeneuve
The current caesarean rate in Canada is
such that nearly 1 in 4 babies are now born surgically. Having
caesareans is more common today than ever before. This is
all due mainly to changes in medical practice, the comfort
level of women and doctors with the perceived risks of birth,
the limited availability of alternative birth options, and
even because of fashion trends. Let's explore each of these
causes:
Medical practice has
changed to preventive medicine shifting away from giving
diagnosis on a case-by-case basis, probably because of insurance
coverage restrictions. Caesareans are now a recommended method
of birth in many pregancy situations such as older women,
larger babies, breech babies, twins, and supertwins. Medical
practice has also made routine labour induction for post-dates
more common even though the risk of caesareans is twice as
high for first time mothers who are routinely induced (Society
of Obstetricians and Gynecologists of Canada, October 1996).
The comfort level of doctors with
the perceived risks of birth has changed as well.
Caesareans are now recommended to women that are largely
overweight, or that have any of a list of medical conditions
such as diabetes or high blood pressure, or that already
have scars in their uterus because of a previous caesarean
or other surgeries. The comfort level of women has changed
as well. They have experienced standard hospital births
with all sorts of interventions, or their friends have,
and they are truly afraid of them. They have experienced
or heard about traumatic vaginal births where the baby
was saved by the caesarean, or would have been saved if
a caesarean had been done. With all of this one-sided information,
to them choosing a caesarean and getting the baby out quickly
appears to be the better way. The fact is that caesareans
are major abdominal surgery, and should usually be reserved
for emergencies. Caesareans carry all the risks of typical
surgeries plus the risks of birth (British Medical Journal,
October 1998). The short-term health risks include: scar
infection, pulmonary embolism, obstetric hemorrhage, postoperative
ileus or intestinal function stoppage, Mendelson's syndrome
or gastric aspiration, hysterectomy, and death. In future
pregnancies, the long-term term risks include organ adhesions,
bladder injury, intestinal obstruction, and uterine rupture
(with either a repeat caesarean or a vaginal delivery).
A caesarean compromises a woman's overall reproductive
health and compromises the health of her future babies
because with a scarred uterus there are risks to future
pregnancies including decreased fecundity, miscarriage,
ectopic pregnancy, and placenta previa. In a study from
the University of Cambridge the chances of miscarriage
were discovered to be twice as high for mothers who had
their first baby by caesarean (The Lancet Medical Journal,
November 2003). Exactly because they carry all these risks,
Caesareans were invented to save mothers and babies in
true emergencies. Caesareans have become safer for the
mother because of the improvements in scar suturing, lower-dose
anesthesia, and the invention of penicillin to prevent
infections, but they are never safer for her than vaginal
birth. Promoting caesarean avoidance and VBAC or vaginal
birth after caesarean is a step towards ending women's
exposure to the risk of caesareans
The limited availability of alternative
birth options (that have shown to reduce the
chances of caesarean) such as waterbirth, homebirth, doulas,
midwives, birthing chairs or stools, and holistic induction
or pain relief methods such as acupuncture, increase the
caesarean rate. First time mothers are not really given
all the options to give birth, while women with previous
caesareans are outright banned from certain hospitals or
not accepted by certain caregivers because they are viewed,
unfairly or not, as high-risk patients. One goal is therefore
to help women avoid that first caesarean because it affects
her future births. But even if alternative birth options
are available, these are not covered by health insurance.
Insurance under Alberta Health Care will always cover a
caesarean in hospital, but it still won't cover natural
birth at home. This is the state in which women are birthing
today. First they work hard to study their options, then
they have to pay for them out-of-pocket. Some choice.
Fashion trends are dictating
the rise in caesareans too. Many famous women publicize their
caesarean sections. It is very rare to see a famous woman
publicize her homebirth or a natural birth without drugs.
For example, the media extensively covered the elective caesareans
of Victoria “Posh Spice” Beckham but not the VBAC-midwife
birth of Cherie Blair, wife of Prime Minister Tony Blair.
Movies and television shows sensationalize the pain of natural
childbirth while underplaying the risks of caesareans. Caesareans
are seen as the sophisticated way to give birth, but then
they never actually show the procedure. If women were shown
what a surgeon has to do to extract the baby from the uterus,
then they would be in a better position to make a choice.
In a perfect world women would watch their
mothers and sisters give birth in gentle environments with
lots of physical and emotional support. These women would
grow confident in giving birth and they would know that a
caesarean is actually a rare event reserved only for the
truest emergencies. In this perfect world no one would be
forced or scared into having to choose a caesarean when so
many birth options were available. In this perfect world
all women would honestly believe that they had options.
Article from July 2004 issue of Birthing magazine,
published by Birth Unlimited in Calgary .
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