Finally, the mainstream media has come out with the beginnings of a critical investigation into birthing in Australia. The Herald today published “Fatal flaws in steady rise of caesareans”. Apparently some Sydney obstetricians have opened a bleary eye and started doing some extrapolating on C section rates, something feminists and birthing advocates have been raising the alarm on for decades. But the people who are causing the problem, the people with the power to change it, have been sitting on their butts about it until the crisis is well and truly in our faces. (Sound familiar? Medical and nursing workforce crisis, anyone? Climate change?)
New South Wales “maternity specialists” have been putting their heads together about the rising rate of placenta accreta. The Herald makes it seem that they’re worried more about the resources implications than about damage to women, but I guess that’s the way to get people’s attention.
At that meeting, convened by NSW Health, officials presented a nightmare scenario: based on current trends a rise in the number of caesarean sections from 30 to 39 per cent of births would mean more than 1000 extra operations a year, diverting resources from other services.
Compare that with the 1970s, when the rate of caesarean sections was about 5 per cent.
By the 1980s caesareans made up about 10 to 15 per cent of all births.
But then came a dangerous combination: medical advances made anaesthesia safer as society moved towards the quick, clean and convenient over the potentially long, drawn out and messy. The result: a significant shift towards elective caesarean sections. The rate reached 19 per cent in 1994, 27 per cent in 2002 and 28.5 per cent in 2003. Now it makes up nearly one-third of all births.
Placenta accreta is a highly dangerous condition in which the placenta adheres to the inner wall of the uterus. Placenta accreta raises the risk of premature birth and bleeding in pregnancy. After birth (whether vaginal or surgical), the adherent placenta doesn’t separate properly. This leads to retained placenta, catastrophic bleeding, hysterectomy (often), or death (sometimes). Sometimes the placenta doesn’t just adhere, but grows right into or through the uterine wall – placenta increta or placenta percreta.
Placenta accreta used to be rare. However, with the rising incidence of primary and repeat Caesarean sections, the rate is rising. People in the UK were warning the world about this expected rise 25 years ago. With every C section a woman has, her risk of undergoing a hysterectomy or other major complications rises and rises. A major Utah study published two years ago delineated this starkly: “Maternal morbidity associated with multiple repeat cesarean deliveries.”:
The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.
Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively.
Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries.
In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
In a Western Australian study published four years ago, it was found that 78% of placenta accreta cases occurred in women who had had a previous C section. 91% of these women required a hysterectomy, and the median blood loss was three litres (a woman’s body only contains about five and a half litres). Placenta accreta is the leading cause of postpartum hysterectomy, an operation with a case fatality rate of 4%.
This is no minor, readily-manageable complication. But many cases are preventable: by not performing unnecessary caesarean section surgery in the first place. The rate of medically-appropriate C sections is likely to lie around 15%. The NSW rate is around 30%; Western Australia is above 34%; and some private hospitals are running at rates well above 50%. And contrary to celeb media beatups, the driver for this isn’t from women who can’t be bothered having a labour and birth; it is coming from the obstetric profession, whose obsession with paternalistic control over women’s bodies is killing women and babies. This needs to stop.