Queensland Mums Afraid to Give Birth?

Image via WikipediaBrowsing the Brisbane Times this morning I came across this article discussing an apparent increase in the number of women requesting elective caesareans for psychological and social reasons.

It's an interesting article for a few reasons. Everyone knows that the caesarean rate has been steadily climbing in the last 10 years - to the point that at 30% nationally, it is now almost triple the rate advised by the World Health Organisation for a developed country. Even the RANZCOG admits that our caesarean rate is too high - that is not in dispute. What has been in dispute though, is why.

Obstetricians argue that we are having babies later, we are fatter, and we are generally more unhealthy during childbearing than our mothers were. They have also been the loudest to proclaim that women are asking them to perform caesareans because they don't want to birth vaginally. Which brings me to the article - I quote.

A National Institute of Health and Welfare report on mothers and babies reveals...a total of 1197, or 6.5 per cent, of caesareans in Queensland were for "psychosocial" or "patient choice" reasons.

So, of all the caesareans being done in Queensland every year, only 6.5% are maternally requested. Six in every hundred. Or put another way, 93.5% of women having caesareans probably got pregnant planning for a vaginal birth. Yep, it seems we are bashing down the doors of obstetricians to book elective caesareans in order to save our pelvic floors, or avoid the agonies of labour.

Our maternity system has some major obstacles to overcome if we are to lower the caesarean rate to anything near acceptable levels. It's incredibly unhelpful to lay blame at the feet of women, and looking at the data near impossible to justify. How on earth have we gone from a caesarean rate of 17% in Queensland in the late 1990's, to double that in only 10 years? It's obvious that there are systemic factors involved here - we didn't all get that old and unhealthy and incapable of birthing babies in just 10 years. Humans just don't "devolve" that quickly. It doesn't make sense.

Hopefully the release of this report will put to rest the claim that large numbers of women having caesareans are asking for them with no medical reason. There are certainly implications here too for the private vs public debate - maternally requested caesareans are often blamed for the massive discrepancies seen in caesarean rates between public and some private hospitals. It looks like that argument won't really stand up any longer either - particularly for those hospitals with rates over 50% (and yes, we have some of those in Queensland).

Labels: Caesarean section, media

Finding a caregiver who supports your VBAC

One of the biggest influences on whether or not we actually achieve a planned VBAC is our choice of caregiver.

It stands to reason that a caregiver who is convinced of the safety of VBAC over repeat caesarean, and who believes in the normalcy of birth is probably better placed to help you achieve your VBAC goal that one who is only "tolerating" your choice to VBAC and would really prefer you to elect another caesarean.

So, how can you find a care provider who is going to back you all the way? And how do you know if the care provider you're already with is one who is completely supportive?

Here's some questions from ICAN (International Caesarean Awareness Network) to use as a starting point for discussion.

• Of the last 10 women that have come to you originally wanting a VBAC, how many were able to have their VBAC? (kind of like asking their VBAC success rate, but this number should represent better, as it will be lower if they tend to talk women out of it during their pregnancy).

• What do you think would prevent me from having a VBAC?

• What do you believe are my chances for having a VBAC?

• I have now read more information regarding my previous c-section, and I’m curious to know what you would do or recommend in the same situation to help me avoid a c-section, either prenatally or during labour?

• At what point would you deem my pregnancy to be too far post dates to continue?

• If I hit 42 weeks (or whatever gestation you would prefer me to birth by), would you consider induction, or just schedule a c-section? If induction, what are my options (rupture of membranes etc.)?

• What circumstances, later in my pregnancy would contraindicate a VBAC and make you recommend a repeat caesarean section?

• If I do go past my due date, what testing requirements do you have (Biophysical Profile, Ultrasound, Non-Stress Test), when will they begin, and how often will I need them?

• Will you recommend an ultrasound to estimate weight late in pregnancy? (providers who are nervous about a "big baby" may recommend ultrasound)

• How do you feel about VBAC’ers birthing "big" babies? What do you think is "big"?

• When in labour, what stipulations do you have for VBACing mums? For example, do you require continuous monitoring? Do you have a time limit for progression in labour (ie, I need to dilate 1cm each hour)?

• Do you prefer your VBAC’ing mums to have an epidural?

• Where is my placenta located? Anterior, Posterior, lower uterine-segment, fundus?

Labels: Caesarean section, careproviders, VBAC

Prevent Caesarean Surgery

Labels: Caesarean section, video