In The News

Daily Mail - Caesarean Backlash

Daily Mail, 11th November 2008 - For years the 'too posh to push' phenomenon has been blamed for the increase in the caesarean rate. Research suggests that actually many of the women labelled in this way are actually too frightened to give birth vaginally. The target to reduce the caesarean rate is forcing these women to give birth in a way that leaves them traumatised and may actually result in an emergency caesarean which carries the most risks and an increased likelihood of recovery difficulties. "Women can request a C-section but for most it's not a possible. So much for women's freedom to choose the birth they want."

The Telegraph - Natural childbirth: whose birth plan is it anyway?

The Telegraph, 30th May 2008 - Maureen Treadwell of the Birth Trauma Association, which supports women who have had difficult births, says that far too often ideology takes precedence over individuals' needs. "The consequences can be unbelievably cruel. The truth is that what suits some women can be distressing and wholly unacceptable to others. Some women are obsessed with a natural birth and are distraught if this doesn't happen. But for others - say, a 40-year-old woman who has had three miscarriages - the priority may be having the safest birth possible with naturalness very low on the list."... the government is discouraging pain relief when more and more women need it. "We're not particularly well designed for birth, and even less so now than at any time in history. Women are getting heavier, babies are getting bigger, we're having babies older and IVF treatments mean there are more multiple births. But our pelvises aren't any larger... Birth is the most physically exhausting thing that is ever going to happen to you, and who is anyone else to tell you how to do it?"

Daily Mail - "Women should be warned that childbirth REALLY is painful, say medical researchers

Daily Mail, 13th Mar 2008 - Antenatal programmes are giving women an unrealistically rosy view of childbirth, researchers warn..."Many women underestimate the intensity of the pain involved and hold an 'unrealistic ideal' for a drug-free birth." Joanne Lally, author of the research, says that "If women can be better educated, they can express their preferences but will also be aware things may not always go to plan...They can then be prepared for different eventualities and so make more realistic decisions and have a better experience."

The Telegraph - Women choosing caesarean have low death rate

The Telegraph, 14th Apr 2008 - Women who have a planned caesarean section birth have the lowest mortality rate, new data has shown... "There has been a lot of confused thinking about caesareans. We need to talk either about elective caesareans or emergency caesareans - not treat them as the same procedure. They have entirely different risk factors." Although maternal deaths are extremely rare, the research challenges the government's policy of reducing caesarean rates. A similar policy has already been abandoned by the National Institute of Health in the US, which now advocates advising women of the risks and benefits based on individual circumstances.

GM TV - "Fear of childbirth

GM TV, 31th Mar 2008 - New research this month has shown that women who opt for caesareans aren't too posh to push, they're terrified of childbirth... Out of the women interviewed 43 per cent of those having elective caesareans had a fear of childbirth that was so severe that it affected their health... In a study carried out in 2000, the women with primary tokophobia (a fear of Birth before they have had any children) strongly desired a caesarean birth. Four achieved this, bonded well with their baby and enjoyed excellent psychological health. Three women endured vaginal deliveries against their will; all suffered postnatal depression, two suffered symptoms of PTSD and two had delayed bonding with their infants.

BMC Medecine - Birth then and now

BMC Medecine, 18th Mar 2008 - An interesting article about how birth trends have change in the last hundred years.

MedHeadlines - Pelvic Floor Disorders Affect Third of All Women

MedHeadlines, 3rd Mar 2008 - The surprising results indicate one in every three women experiences one or more of these disorders over the course of a lifetime, but not necessarily as they age. Vaginal delivery, but not cesarean delivery, is closely associated with these disorders... These conditions have a significant effect on quality of life but many women consider them something to be dealt with silently instead of sharing their experiences or getting them corrected... Since these conditions have long been considered a matter of aging, younger women who experience them seem reluctant to discuss their symptoms, either with their friends and family or with their physicians. Women of all ages are affected, however, especially those who have given birth vaginally. Vaginal deliveries seem to double the rate of pelvic floor disorders compared to women who have never given birth or those who had Cesarean deliveries.

Daily Record - Scientists Reveal New Medical Condition: Mumnesia

Daily Record, 6th Mar 2008 - MUMNESIA - what a fabulous bulletproof excuse to explain why my head has been in the clouds since my daughter was born... "When people don't sleep, or if their sleep is fragmented, events of the day may not be consolidated into long-term memories." Breast feeding, although best for babies, can make forgetfulness worse too. That's because it produces drug like hormones which help women relax and feel less focussed. Team this up with oestrogen hormone levels plunging from an all-time high in late pregnancy to practically non-existent after the baby arrives then no wonder you can't find your car keys and struggle to finish a sentence.

Medpage Today - Pre-incision Antibiotics Reduce Infection Risk After Caesareans

Medpage Today, 5th Feb 2008 - Surgical-site infections after Caesarean deliveries decreased by more than half when a teaching hospital began prophylaxis before the incision rather than after cord clamp, said investigators here.

E! Online - Do stars get tummy tucks with their C-sections?

E! Online - Contrary to popular opinion, stars in the States do not get a tummy tuck with their caesarean. "The chances of infection are too high, for one," says Dr. Randy A. Fink, a Miami-based fellow in the American College of Obstetricians and Gynecologists. "And the muscles have yet to recover. I wouldn't do it, and I don't know many others who would".

The Observer - Why mothers should be offered caesareans

The Observer, 5th Mar 2006 - Professor James Walker, head of obstetrics and gynaecology at St James's University Hospital, Leeds - "The idea that caesarean section is per se dangerous and therefore should not be done is simply untrue. If you look at the data surrounding the birth itself, you could make the argument that an elective caesarean is actually the safest approach, simply because it avoids all possibility of needing an emergency caesarean, which carries the highest risks of all."

The Guardian - Natural Caesareans - Every bit as magical

The Guardian, 3rd Dec 2005 - Fisk believes that "while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans." He feels that in non-emergency situations "caesarean birth can be gentle, just as vaginal birth can be gentle". Fisk is particularly keen to address the concern that caesarean babies are at increased risk of breathing difficulties because they are not squeezed through the birth canal. He believes that "by leaving the baby's body inside the uterus for longer once the head is out, the body is squeezed and you see the lung liquid coming out of the baby's nose. Unless there are other risk factors, I've never known a baby born by my method to have problems - going straight onto the mother's chest helps regulate breathing."

The Observer - The safest method of birth is by caesarean

The Obverver, 2nd May 2004 - Nicholas Fisk Professor of obstetrics at Imperial College, London. Sara Paterson Brown is a consultant obstetrician at Queen Charlotte's Hospital, London. "Obstetricians spend much of their time exploring reasons why women ask for caesarean births. Sometimes we feel like a recording, going over and over the same pros and cons surrounding the delivery of their child. But now the National Institute for Clinical Excellence (NICE) wants us to dissuade women from such requests. Its reasons are straightforward: a short-term cost saving of £11 million and a political view that maternal choice is fine, as long as it is towards natural childbirth."

Listening to Mothers Survey Results

"The second national U.S. Listening to Mothers survey was carried out in January-February 2006 among women who gave birth in 2005...1,574 women described their experiences planning pregnancy, being pregnant, giving birth and during the postpartum period." 75

The findings in summary:

• Requesting caesareans for no medical reason - "just one woman (0.08%) among 1315 survey participants who might have initiated a planned primary cesarean without medical reason did so...Applying this to the most recent national figure for annual births, an estimated 2,616 women out of about 4.1 million who gave birth in 2005 had primary no-indication maternal request cesareans."
• Reasons for the increase in caesarean rates in the U.S. - "Numerous legal, clinical, financial, social and other factors contribute to rising cesarean rates. These include professionals' fears of legal claims of malpractice and lawsuits, the failure to offer women care that lowers their likelihood of having a cesarean (such as continuous labor support or hands-on-belly maneuvers to turn babies to a head-first position), and widespread failure to offer women with a previous cesarean or a legs- or buttocks-first (breech) baby the choice of vaginal birth."
• Pressure to have a caesarean - "Nine percent of the mothers reported experiencing pressure to have a cesarean. This pressure from professionals to have a cesarean vastly outweighs the pressure from mothers to have one...Forty-two percent felt that the current system leads maternity care providers to perform a cesarean section that is not really needed to avoid being sued."
• How informed were women prior to their surgery - "The survey asked participants how much they agreed or disagreed with four statements about side effects of cesareans, including shorter- and longer-term effects on mothers and babies. From 42% to 45% of the mothers were "not sure" about how to reply to the four items, and an additional 21% to 33% responded incorrectly. These results raise serious concerns about the adequacy of current informed consent processes for this major surgical procedure."
• Availability of VBAC - "...just 12% of the women with a previous cesarean in the survey had a VBAC in 2005. Of the remaining women who had a repeat cesarean, 45% were interested in the option of having a VBAC, but more than half (56%) of them were denied this option, primarily because their caregiver (45%) or hospital (23%) was unwilling to do a VBAC."

Results from NIH (National Institutes of Health) conference in USA in March 2006

A panel of scientists assembled by the US National Institute of Health earlier this year called for further research into the effects, both positive and negative, of caesarean births and highlighted the need to improve the information available to women making birth choices. 84

The panel's primary recommendations were:

• That risk to future pregnancies means that women planning more than one or two children should not have a purely elective caesarean. Topping the concern is that a prior caesarean significantly increases the risk of a life-threatening placenta problem in a later pregnancies.
• Newborns are more likely to have respiratory problems if they're born by Caesarean, regardless of the reason for the surgery. So doctors should perform elective C-sections only if they're sure the woman has reached at least 39 weeks of gestation, when foetal lungs are fully mature.
• Full-term pregnancies are typically defined as lasting 40 weeks from the start of the last menstrual period, but gestational age can be difficult to measure correctly. The March of Dimes last week reported that most births now take place at 39 weeks, a change the non-profit group attributed in part to pre-planned C-sections, which it fears also may drive inadvertent delivery of slightly premature babies.
• Doctors should never bring up the option of a purely elective C-section. But if a mother-to-be requests one, the health provider should determine her reason for the request and help weigh the risks and benefits.
• If the woman's reason is a fear of pain during labour and delivery, doctors should help her choose from among the multiple safe options to avoid that; pain-numbing epidurals are the most effective.

Dr. Mary D'Alton, (Obstetrics chief at Columbia University Medical Centre) who chaired the panel said of caesareans, "we don't believe it should be discouraged or encouraged," concluding that there are important pros and cons to the different methods of childbirth. "There's not one right answer for everyone."