Midwifery school update and my first post that uses the word vagina!
So today we discussed the statistics/differences between normal (vaginal) birth and Cesarean sections.
Most especially, we discussed the perception that C-sections are somehow “easier” than vaginal deliveries, and somehow less scary because there are “less risks”. With the rates of C-sections increasing (and fear of vaginal births increasing too) studies around this seem important for all maternity health care providers and expectant parents to understand.
Some facts from Dr. E. Hutton’s presentation today stood out to me, so I’ve shared them below. I’ve tried my best to reference where the facts within that presentation have been sourced. Hopefully you find it insightful and will give a perspective about where we are at today with C-sections in North America.
(I’m not going to lie, it’s not all great news. Someone else can write that blog, I didn’t learn about those facts today).
Fact 1: The rate of C-sections is increasing, and today represents about 29% of births in Canada (planned and unplanned). That is more than 1 in 4 women. In the USA, rates were 5% in the 1970s and are now more than 30% today.
The WHO recommends a 15% C-section rate. That rate would represent enough surgeries to improve birth outcomes.
Fact 2: women are more fearful of vaginal deliveries. Cue any movie seen anywhere that shows water breaking leading to IMMEDIATE PAIN AND HORRIFYING TERROR.
The term “too posh to push” was thrown around today. Women are getting elective C-sections because they “don’t have time” for labour, or have a fear of tearing/incontinence that may never happen. It’s makes me sad, because birth can be such an amazing thing. But with celebrities like Christina Aguilera saying that she chose a C-section because of her fear of tearing, and then adding that the “hardest part was choosing his birthday” … well, you decide if recovering from major abdominal surgery “easy” …
Fact 3: Maternal mortality rates due to C-sections have risen since 2004, the first significant rise since 1977. So to put it into context, women in North America are dying from C-section complications more than before, and are sometimes getting C-sections that aren’t necessary. Compare that to Haiti, where the C-section rate is 1.6% and women are dying because they do not have access to life-saving C-sections.
So in one case, death is occurring because of lack of access. In another, death occurs because of too much access. That’s crazy!
Fact 4: C-sections tend to be higher in city centres, lower in regional areas. Regional areas may not have access to operating rooms for C-sections, but outcomes are not always worse.
Fact 5: C-sections cost money. $6,000 compared to $3,600 for normal birth. “Giving birth in Canada” says that over 343,000 births were recorded in Canada in 2006, and if we followed the WHO guidelines of 15% C-section rate, we would save 93 million per year. That’s a whole lotta dollars!
Fact 6: Studies show that there is an increased risk of post-partum problems (morbidity) with C-section when compared to vaginal delivery. The Liu and Liston, et al (CMAJ 2007) study found increases in:
- Cardiac arrest
- Post-partum infection
- Haemorrhage (uncontrolled bleeding)
Another interesting one: about 2% of babies will have a small cut on them when born with C-section (Smith, 1997).
Fact 7: There are some common reasons for anxiousness toward vaginal birthing and an increased tendency toward C-section:
- too posh to push
- low fetal risk tolerance (people don’t want babies to die, go figure)
- normalization of C-section (per facts 1-2)
- concerns re: continence
- malpractice litigation (because getting that baby out means it’ll be ok, so its safer just to go to C-section. Afterall, the doctor knows best about labour progression … right?)
Something to consider: doctors don’t see the birth in whole stages. Often, obstetricians come in, check, and leave. Midwives are present for the entire process of birth, and can often make a broader decision (with the woman) about how labour is progressing. ‘Get that baby out fast’ isn’t always the answer.
Fact 8: In 2009, 3,680 UBC students were polled about how they would want to welcome their first baby into the world. Stoll, Fairbrother, Carty 2009 found that 9% of men and women polled would choose C-sections. Without knowing the facts, they automatically chose the surgery.
I want to say that sometimes C-sections are absolutely warranted, and that each birth is different and requires individual evaluation. I am also NOT anti-doctor, I know some lovely physicians who make great decisions.
Of course I’m hoping that I’ll learn facts about vaginal delivery to provide some balance for these C-section facts, but I thought I’d share because I found the research so enlightening!
(Plus I’m going to be a midwife who promotes normal, low-risk vaginal birth, so …)