Parenting, Uncategorized

A Section of Society…..

A fortnight ago, I heard about the latest ESRI report on the fertility of Irish women. It’s taken me a while to address the most disturbing statistic revealed in that document, but I’m finally getting around to it.

 

Caesarean section rates in Ireland have increased. They are steadily creeping up and now stand (or lie!) at almost 25%. Bearing in mind that the WHO recommends that the C-section rate should not be more than 15 percent in any country – least of all a developed one where difficulties associated with vaginal birth, like malnutrition and FGM resulting in damage to the birth canal are virtually non-existent.

 

The day after these figures were released, I heard Peter Boylan of the National Maternity Hospital in Holles Street giving reasons why we are now more than ten percentage points above the recommendations of the WHO.  I was just going to tweet ‘There’s Peter Boylan talking bollocks’, but I decided instead that it might be more useful to deconstruct his argument.

 

Boylan’s main arguments for the rising increase revolved around the following:

1. We now have women who are ‘much older’ giving birth for the first time.

2. There are more IVF babies.

3. Breech presentations lead to more C-sections.

4. Women have a ‘natural tendancy’ to worry about their pregnancies and think that anything that can go wrong will go wrong.

 

Unfortunately, none of these ‘reasons’ is an evidence-based reason for cutting women’s abdomen’s open in order to extract their babies.

 

That Irish women are ‘much older’ giving birth for the first time, is an interesting piece of demographic research – not a reason to insist they undergo major surgery! In a search of scholarly articles, I could not find a single shred of evidence to suggest that being over 35 or even over 40 was in and of itself a contributing factor to risks that would necessitate a C-section. Not one.

 

As to Boylan’s assertion that IVF babies are more likely to ‘need’ to be brought into the world via surgery – there is no evidence to suggest that a pregnancy achieved through IVF does not proceed exactly the same way as every other pregnancy. Therefore, there is no evidence to suggest that any more than 15% of these births should be ending in Caesarean-sections.

 

Breech presentations, as any good midwife knows, are a variation of normal. A breech birth, therefore, is a ‘normal’ birth and should be treated as such. The problem is that the knowledge and skills necessary for attending a breech birth are being lost and ‘normal’ is regarded as ‘dangerous’.

 

I don’t think any of Peter Boylan’s ‘reasons’ for the rise in C-sections is quite as arrogant, condescending, patronising or stems from a more patriarchal place than his assertion that ‘women have a natural tendency to worry about their pregnancies and think that anything that can go wrong, will go wrong’.   Women don’t have a ‘natural tendency’ to assume that their pregnancy is doomed from the outset. We don’t need a doctor to pat our hands and tell us that they’ll take care of everything for us! Women, in fact, don’t worry about anything until it is suggested that there is anything to worry about. And who plants these seeds of doubt and worry? Why, the doctors, of course.

 

If, as Peter Boylan was suggesting, these natural worrying tendencies of women are responsible for the rise in C-sections, I wonder where he feels the responsibilities of doctors lie? Should they not be reassuring women with actual, cold, hard facts on the outcomes of pregnancy and childbirth? Should they not be reassuring women that pregnancy and birth are perfectly normal, everyday occurrences? Should they not be informing women that the outcomes for then and their children are better if they just allow nature to take her course?

 

In her piece in the Irish Times on June 26th, Dr. Jacky Jones reminds us that  ‘Fooling ourselves that the birthing process is safer for women when doctors are in charge is the ultimate example of group-think. The vast majority of women are able to give birth without surgical intervention so doctors are redundant except in about 10 to 15 per cent of cases. Obstetricians spent the 20th century inventing surgical and mechanical ways of interfering with a natural process to ensure they were not redundant.’

 

Unfortunately for women and their babies, Dr. Jones is right. I don’t want to vilify all doctors; they’re not operating from a place of greed many of them genuinely believe that they have women’s best interests at heart; but they forget that they are trained in the ‘abnormal’.  Their expertise is in intervention when things go wrong. As women have increasingly handed over their power to male doctors – and female doctors trained in a medical model that was invented by men – the amount of intervention in normal births has increased.

 

Dr. Marsden Wagner, who was formerly the WHO’s Director of Women’s and Children’s Health, wrote about this phenomenon in his seminal piece ‘Fish Can’t See Water’  which points out that because doctor’s don’t know any better, they can’t do any better.

 

It makes me very, very sad that women are continuing to hand over their power in this, the most feminine of arenas, to men. Until we stand up and wrest our power back from the patriarchal system that Birth is embedded in in this country, we can never truly expect the lot of women and children here to improve. As long as we are happy to be compliant, we will continue to be complicit in our own subjugation.

 

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2 thoughts on “A Section of Society…..

  1. Louise J. says:

    Have you researched the proportion of Caesarian sections requested by the mothers themselves? If a worried woman requested a section and her “arrogant, condescending, and patronising” obstetrician refused to perform it, would you support him (or just as likely her) in overturning her choice for the birth of her child? Have you researched the proportion of sections requested by harassed midwives on too busy labour wards? Have you seen experienced obstetricians decide to perform a vaginal delivery even though they may later face litigation from parents who expect a “perfect” birth – whatever that is? Have you considered anything other than the tired old argument that all obstetricians are patriarchal and arrogant, and modern women remain apparently incapable of speaking up about their pregnancies and labours, somehow intimidated into silence in 2012? Just a few questions to expand the debate!

    • Hazel Katherine Larkin says:

      Hi!

      Thanks for your comment – and apologies for taking so long to reply; am in dissertation hell at the moment!

      The purpose of my post was to address Peter Boylan’s comments, not necessarily discuss every aspect and element of the debate.

      What I would love to see is women making informed choices. Informed choice can only be made if a person is informed of all the possible risks to the decision they are thinking about making. It means that the professional in whom the woman trusts goes through with her the benefits, risks, alternatives, and looks at what her instinct tells her. It would also mean discussing a woman’s fears and desires in depth. Unfortunately, unless a woman can afford/find an independent midwife who will attend her in the comfort and safety of her own home, that is likely to happen.

      To answer your question about a worried woman requesting a section and a doctor refusing it – I think the doctor has a duty of care to discuss the woman’s fears with her and find out why she is worried and why she feels she needs/wants a C-S. In my work as a doula, I supported two women who requested C/Ss. One had been so traumatised by her first birth (badly managed, horrendous treatment of Mum, Dad & Baby) that it took ten years before she could consider having a second. The other woman had been through an horrific accident in her late teens. She nearly died and her pelvis and leg were damaged to the extent that – when she survived – she was told she’d never walk again and that she’d certainly never have children. She wanted a CS because she really couldn’t bear the thought of more pain and was worried that she’d labour for a number of hours only to be told she wasn’t progressing and would later need a C/S anyway.

      Of course I supported these women’s choices – because they made informed choices. So many people don’t.

      In Ireland, midwives don’t ‘request’ CSs – though they may suggest them. I’m afraid I don’t understand what you mean about ‘experienced obstetricians deciding to perform vaginal deliveries’. In my experience, women deliver babies – not their obstetricians.

      Unfortunately, from my position, and the position of many thousands of women who suffer at the hands of a non-evidence based ob-gny system – the Irish one is patriarchal and arrogant and women ARE intimidated and bullied into silence and accepting treatment that is not in their own best interests. However ‘tired’ and ‘old’ you feel the argument is – it’s still a valid one because not enough has changed.

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