Next up in my “What the fuck” series is ABC’s “AM” programme.
Today’s show was titled “Caesarean rates surge“. [emphases are mine]
Tony Eastley’s introduction:
The number of pregnant women requesting caesareans for psychological or social reasons has increased by 50 per cent over the past ten years, according to a new health report.
The Australian Institute of Health and Welfare says 2,500 women opted for the procedure last year for ‘psycho-social’ reasons.
Obstetricians say the big increase has a lot to do with vanity.
Rachel Brown then interviewed obstetrician Dr David O’Callaghan, who had this to say:
RACHAEL BROWN: Why do you think they prefer caesareans?
DAVID O’CALLAGHAN: Oh first of all I’d say we’re dealing with very small percentage of women in this case […]
RACHAEL BROWN: Do you hear of many women requesting a caesarean for vanity reasons?
DAVID O’CALLAGHAN: In my experience what people term the concept of being ‘too posh to push’ is exceptionally rare. I’ve only heard a mere handful of women ever ask for that.
So who are these “obstetricians” who “say the big increase has a lot to do with vanity”? That wasn’t a massive handwave that was actually the complete opposite of the actual datum presented, was it?
I don’t suppose anyone in the MSM wants to take a look at the actual reasons behind the massive increase in surgical birth? And the reasons why popular culture wants to blame women?
…. Bueller?
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Vanity doesn’t even make sense on its own terms. I mean don’t caesarians leave big scars?
I see your what the fuck and raise you a flaming.
Is the increase because :-
1 they can.
2 The first birth is happening later and later. if you want to just ‘pop’ them out – start young.
3.things down below are not affected by the passage of a lumpy baby.
4. other people do it.
5 it dont hurt much
Actually they largely use the (shudder at the term) bikini cut, which minimises how visible the scar is, but SunlessNick, the “vanity” they allude to is probably about how one’s genitals look after birth. Because we’re all supposed to have, these days, a perfect labia. Whatever that entails.
As someone who’s had two caesars, one emergency, one bullied, I’d like to take issue with some of your points John:
1. I didn’t have a caesar because I could, I had the first because the private hospital I was in decided that after 8 hours of labour that I needed one, but my son was still born with apgars of 9 and 9. The second time I was told that if I selfishly insisted on a vaginal birth, my baby could well be born dead. Not much of a choice.
2. A girlfriend of mine, 3 years older than me has had two vaginal births, no problem, as do thousands of women around the world every day.
3. I don’t even understand what you mean by this.
4. I don’t give a stuff if other people do it.
5. It fucking hurts like hell when you wake up and they force you out of bed into the shower the first morning. It hurts for weeks afterward, it is after all major abdominal surgery.
The vanity argument here in the US, iirc, was more about a planned date of birth/convenience, as were inductions. There was a truly heinous story a year or two ago of a couple who induced so they wouldn’t miss the football game on Sunday…
Sigh. It does leave quite a scar–yours truly was born that way, and Mom’s got one. Major surgery, as Mindy says.
john cramer, I suggest listening, or asking respectful thoughtful questions. You can start by reading all my other posts about birth, and the comments therein: all your questions are well and truly answered.
Mindy speaks truth. Especially the bit about how a C section fucking hurts like hell – something the obstetricians don’t actually see in their head-pokes around the door postop and their early discharges. Go to a meeting of mothers on day two to five and watch them take two steps – you’ll know exactly who had a normal birth and who didn’t.
And C section, with the “bikini cut”, (which is supposedly below the pubic hair that we’re all supposed to be removing within an inch of its life these days), leaves a shelf of adipose tissue jutting out above the scar, as well as often leaving a large numb area on the abdominal skin.
I’d say the increase has a lot more to do with obstetricians than the individual women.
Obs are paid more for c/s than vaginal birth, Obs are the ones threatening women with death for themselves or their baby if they don’t comply with the Ob version of ‘what’s best’. Obs are the ones benefiting from a rising c/s rate, women certainly aren’t.
Do any of you know what the C section rate is a done by female versus male obstetricians?
Of course C sections hurt but that is afterwards – labour pain is much better known.
If all my reasons are wrong why are all these independent feminist women submitting to C section.
They could always refuse the procedure. Their grandmothers never had such operations and still produced children that in turn produced you.
Is it time for Obstetrics 101 to complement Feminism 101?
Feminists, and other women, consent to ceasarians because they have doctors who tell them their baby is likely to die without it. I’ve never met a mother who felt like gambling in those circumstances, and most of us, however well educated we are, are not obstetricians, and do not have the specific education required to make an informed decision. Doctors, on the other hand, have plenty of education, and the capacity to do research, and the capacity to decide who gets surgery and who doesn’t. They’re doing more and more surgery, despite the evidence, so why aren’t the mainstream media questioning them?
> They’re doing more and more surgery, despite the evidence
Despite what evidence? My experience (1 natural stillbirth (known stillbirth beforehand), 2 live caesars) is that (a) doctors know how painful a caesar is. (b) doctors believe that a natural birth is preferable for the mother, but is more out of their control if things go wrong. (c) for liability reasons they prefer not to have natural births if there is already something known to be wrong. (4) Mothers-to-be are well informed about the pain involved in a ceasar – after all, they will seek advice from the mothers they know, which will include a range of birth options. And they are hard to recover from.
err, my experience is on my wife’s behalf – thought I should clarify that 😉
My mom had her doctors screw up the drugs in her c-section. It was incredibly painful for her. The doctor bullied her for his own reasons and schedule. Mom was trying to do what was best for her child (and the c-section really was the best choice in the circumstances).
I vote John gets the troll avatar. Women’s lives are put at risk because of men moralising about women’s health. Some c-sections really are neccessary to save lives. Many women would be alive and grandmothers today if they were widely available way-back-when. Also, “pop them out”? What the hell?
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Oz Ozzie, have you read what I’ve written before on birth? So that we don’t have to have the same conversations over and over again?
“Doctors believe they have more control” is not evidence-based care. “Doctors believe they’re less likely to be sued with a C section” is not evidence-based care. And doctors, on the whole, are not fully informed about the pain after a C section, in my experience (of being a doctor, of having many many conversations with my colleagues, and of having had a C section myself and talked with many women who have).
It’s blatantly obvious that the public/private divide is inexplicable in terms of medical need.
And it’s blatantly obvious to anyone who’s had the slightest peep at evidence that our induction rates, vaginal examination rates, AROM rates, birth positioning routines, and episiotomy rates are simply unjustifiable.
Some doctors believe a normal birth is better for mothers. Many don’t. Many more say “well, it’s nice if you can have one, but many women can’t, and our C section rates are just fine”. Lots joke about “vaginal bypass surgery”. Some assert “nothing good happens after 38 weeks”.
john cramer, go read the comments policy, or go away.
Reading the ABC take on the issue reminded me of some research I read years ago. I’ve tracked it down:
http://www.mja.com.au/public/issues/jun21/turnbull/turnbull.html
It is ten years old now, but their findings, particularly those about women being properly informed before consenting to a caesarean procedure are still valid in my view. I’m sure there must be more recent evidence, however.
hi Lauredhel
err, no, I don’t recall reading you on this particular subject before. I did knowingly duck the evidence based issue, because if I didn’t I was going to have to spend a number of hours reviewing the papers before making comment. Or at least, I should do that.
So I presume you have, and the evidence isn’t there. Yet our obst was sure about it – and I asked him: he said that he preferred a normal birth, but given our particular history, this wouldn’t be wise – less stress on the baby (placental insufficiency in our case).
If there evidence isn’t really there, why do they happen? few mothers I know – this is regular discussion in my social circles her in baby-boom melbourne – want to have a ceasar, so the drive must come from the obsts. are they better remunerated for a ceasar?
what kind of doctor are you?
I saw about five obstetricians, as well as various doctors, midwives, students, etc – and the only person that ever mentioned a c/s to me was the one that ended up cutting me open.
Lord knows whether it was actually necessary or not, maybe it was, but the fact that it was the scalpel happy doctor that did the deed makes me very suspicious. I’m planning on asking for my medical records and trying to get more information, but being tarred with the “too posh to push” tag just adds a very low insult to a nasty injury.
P.S. I agreed to the C/S because I was told that my baby would probably not survive a vaginal birth, and I didn’t have time to get a second opinion. He did survive, and because of that I’ve been told I have no right to complain – at least he’s healthy!
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My 5 cents worth: I had thyroid surgery last year. Technically, it was elective. But nobody thinks that I marched into the surgeon’s office and demanded he take out half my thyroid. Of course I followed the medical professional’s advice (why wouldn’t I?) So why are elective caesars so often represented (in the msm at least) as being all the woman’s decision when other kinds of elective surgery are not?
JenniferV: One of my pet peeves is the misrepresentation of elective surgery as on-a-whim surgery.
Elective surgery is any surgery that is scheduled rather than “clear the OR, we need it right this second”. As far as a hospital is concerned, heart transplant surgery is an elective procedure. All sorts of life-saving surgeries are elective procedures. Elective surgery is often good and necessary to improve the quality of life as well as actually saving lives.
Not everything that is a terminal condition is an emergency terminal condition. Childbirth is complicated by having two lives to consider.
If you want to know the natural emergency caesarean rate and natural necessary elective caesarean rate, check out the contrasting figures (as Lauredhel notes) between public patients and private patients, and ponder the possible sources of that discrepancy, when all prenatal surveys show that wealthier/more-educated mothers are precisely the ones who are most gung-ho about natural birth as well as the ones most likely to have a private obstetrician.
If I am a troll tell me the cesarean rate by women obstetricians. But if you only want assent just say so.
The real problem with the C section is that it was basically introduced for the elite and now has rather become a supermarket thing.
BUT plenty of women ask/demand it. The doctors are the ones that get persuaded/bullied.
As for the scar – it is done on a belly not best fitted for plastic procedures. Scars can be tidied up later.
Oz Ozzie: “few mothers I know – this is regular discussion in my social circles her in baby-boom melbourne – want to have a ceasar, so the drive must come from the obsts. are they better remunerated for a ceasar?”
Yes. Medicare item 16520 for c-section has a listed fee of $563.40 whereas the listed fee for management of labour and delivery (item 16519) is $482.05.
This situation is compounded by item 16522, management of labour and delivery, or delivery alone (including c-section) where there are various complications – including actual complications, but also including “prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress” – which is the most common reason for performing a c-section, and which is, to speak frankly a total crock of shit.
But it pays $1,131.85.
So basically, whack a label of “failure to progress” on a woman who’s been in labour 12+ hours (even if everything is actually going fine, baby’s heart rate is normal etc), do a quick c-secion, home in time for dinner and you’ve doubled the Medicare rebate.
Or show some patience, miss dinner, and cut your pay in half for a normal birth.
Lara: “P.S. I agreed to the C/S because I was told that my baby would probably not survive a vaginal birth, and I didn’t have time to get a second opinion. He did survive, and because of that I’ve been told I have no right to complain – at least he’s healthy!”
There are two people physically involved in a birth – a woman and a baby. People who say you have no right to complain because “at least you have a healthy baby” are completely and utterly disregarding your experience as unimportant, irrelevant (not a new phenomenon to feminists). You are just the uterus, your experience doesn’t count. It’s completely, utterly screwed up, and ignores the very real trauma women suffer because of destructive maternity care. I highly recommend Sheila Kitzinger’s book Birth Crisis , about how women come to terms with what she characterises as feeling like you have been swallowed up by a vast machine and spat out at the other end with a baby.
alright, Medicare is screwed up. Not the only place. Though I’d be interested to compare costs as well as remuneration. My experience with medicare is that this is always something to factor in – sometimes it’s less screwed up than it looks – and sometimes more.
As far as being swallowed up by a vast machine and spat out, we felt that way a bit (having private medical insurance may have helped). But everyone thinks things are better than they used to be, back in our parents day. Not that this is aiming very high, of course.
If you want to look at costs as well as remuneration, you need to compare time as well – a c-sec takes under an hour (absent complications), and a physiological labour with a first baby might take over 24. A friend I was doula for took over 48 with her first (most of it at home, which helped to avoid unnecessary interventions).
And not everyone thinks things are better than they were for our parents. In the 1970s, when my mother had me and my brother, the rate of caesarean sections was about 5% – now, it’s over 30% and higher in the private system. Other interventions – induction (earlier and earlier) for example – have also increased, despite evidence that they may be doing harm. At the same time, maternal deaths per 100,000 live births have basically not shifted (there has been movement up and down, but no downwards trend). Neonatal mortality has improved, but largely due to two factors – pre-natal screening to detect congenital malformations that are not compatible with life, and better neonatal intensive care.
So how exactly are things better than they were for our parents? If you believe that medicine is necessarily connected with progress, and that more medicine = better, then maybe things have improved. If not, the evidence is to the contrary.
Agree about time. But there’s operative costs, aneasthetists (is that a separate line item? Can’t recall), etc. Anyhow, the proof is in the eating, so there’s at least something wrong here.
As far as how things are better? Both my Mum and my dreaded MIL had the same experience – as soon as the baby was born, it as off, gone, no chance to hold and bond. Feeding was a process done with military precision on the appointed hour irrespective of wishes of baby or mother. My mum claims that she nearly had a breakdown listening to me scream, her being not allowed to feed me whilst in hospital, nor to have me in her room. I have heard similar comments from other women my parents age. Fortunately I am apparently unaffected by this great trauma, though I think this is not true for my mum, even today.
I only claimed that the experience of being spat out by a vast uncaring machine had improved since their times. I make no other claims 😉
john cramer:
This isn’t an “all men vs all women” conversation, john. The fact that individual women participate in dominance structures doesn’t mean that the structures don’t exist. Go back to square one reading about feminism, please. I recommend “Finally, A Feminism 101 Blog”.
So if women don’t want to be oppressed, all they have to do is say “No”? Awesome! Sexism solved!
If you’re participating in good faith and interested in learning, you’ll go read _all_ of FF101 right now, and, as suggested already, you’ll read what I’ve written before on birth. (Hint: there’s a search box up and to your right.) If not, well, buh-bye.
Rachel: thanks very much for that paper. One of the really telling figures in it for me was this:
Which certainly speaks to the “women in private hospitals have more C sections because they demand them” myth.
Lara and Rebekka: The “you’ve got no right to whinge, you got a take-home baby” dismissal I could rage on about for hours. No one ever tells someone who’s survived a horrible car crash or been through chemotherapy or had a twisted bowel that they should “shut up and be glad they’re alive”. Women have every right to feel the emotions they feel after surgical birth. Either they’ve been roped into surgery they didn’t need, or something has gone horribly wrong with their body (or there’s no way or telling which) – and they’ve been through an unpleasant, painful, worrying procedure, one that puts them and their baby at risk in various ways, as well as being deprived of a joyful birth and a rapid recovery while enjoying their new baby.
Theatre fees, anaesthetic fees, hospital bed fees are all charged separately. The ob fee is purely for their services. Plus, with elective Cs, you can run them back-to-back on a list with about a 40 minute turnaround (quicker with an extremely efficient theatre and surgeon or running two theatres), so an OB can easily dash off five in a morning without so much as waking up early. Sociable hours, compliant patients, and no waiting around.
This is absolutely horrible (having been through it myself). Unfortunately, separation is much more common with C section than with normal birth. Babies are likely to be separated straight after birth, and more likely to be admitted to a special care unit, breastfeeding is more difficult. Which is one (of the many) reasons many women object to unnecesareans.
Plus, I’m really sorry about the back to back posts, everyone. I’ve tried to separate out my responses for easier reading, but I don’t mean to dominate the thread. I’ve been distracted myself over the past 24 hours with medical unpleasantry, and am just now back.
> Unfortunately, separation is much more common with C section than with normal birth.
yes. It’s a hard hard road after a ceasar, specially if the child is prem.
But for my M and MIL, there was not even this excuse – we were both natural births, though my wife had her collarbone snapped by forceps. Is it good that I no longer hear about forceps? I wonder
Oz Ozzie, you’re of course dead right about those other things – time to bond, rigid feeding regimes, etc. I was focused on the act of birth and medical interventions. Mind you, I don’t think everything is now hunky-dory in that area – there are 144 public hospitals in Victoria (just as an example), but only 25 Victorian hospitals have achieved baby friendly accreditation (and some of those are private) (The Baby Friendly Health Initiative basically consists of ten steps that support breastfeeding – there’s nothing terribly complicated in it).
Interestingly, my grandmother has told me how difficult it was feeding on a four hour schedule, and how upsetting she found it having to wait to feed a hungry baby – my mother was much more lassiez-faire about the whole thing. Perhaps your parents are older than mine?
I and my wife were born in the late 60’s. Not that different?
There’s real differences between different mum/baby pairs. Our first always wanted to slip into a feed every 45 minutes, specially through the night (yuck), but the second was perfectly happy with a four hourly cycle. Maybe that explains your mother/grandmother?
It may also be individual variation between healthcare workers, and/or variation between how much mothers pay attention to them! There are still plenty of people around who recommend scheduling, for no valid reason at all. Check out ezzo.info for some scary stuff.
There is absolutely no way I could have scheduled my son’s feeding like that. His tummy only fit 60 ml in it for quite a long while. Even with round the clock three hourly feeds, that would have been no more than two-thirds of his food needs (when he wasn’t in an appetite spurt).
Thankyou for posting the book rec, Rebekkah. I know it wasn’t directed at me, but I will check it out.
I have had two bouts of “elective” surgery in the past 7 months. The first was for the birth of my son. As he was breech I was flat out TOLD that I would be having a caesarean by one of the doctors at my local (public) hospital – even before I developed late-term hypertension. I had to ask about having an ECV (external turning) and the doc was clearly taken aback when I did, though he ended up agreeing to try. One of the midwives blithely told me “They” didn’t do breech vaginal births anymore because caesareans were “safer”. Considering that he spent some time in the NICU as a result of swallowing the mucus that a vaginal birth would have forced from his airways, I couldn’t help but wonder who exactly it was “safer” for?
(Lara – I’ve gotten that “no right to complain” too, and it drives me crazy. Women’s bodies and experiences are not lesser than a baby’s. It’s such a classic silencing technique, that says more about the speaker’s discomfort with the topic and lack of empathy and consideration than anything else. I’m sure I’ve read British colonial “what right do they have to complain?!” crap about the people of the Congo, etc.)
That would be weird Aphie, because the King of Belgium colonised the Congo (as his own personal property).
Sorry Laura, Heart of Darkness on the brain, I think?
Will try to find the actual piece(s) was thinking of.
…or not. Bookmark’s gone and my google-fu fails me.
Quite probably misremembered anyway, sorry.
“you’ve got no right to whinge, you got a take-home baby” dismissal I could rage on about for hours
Please do. This is a crock, and the absolute worst thing a woman can hear when she is looking for some way out of the pain that a medicalised birth imposes. I had other issues going on at the time, but thanks to a wonderful social worker I quickly realised that I was feeling horrible about my birth experience, and I also realised WHY. And then I was able to get past it and deal with all the other crap – but i think reading this book will be great – I loved reading Sheila’s childbirth books in preparation for my birth, I anticipate that this book will be as affirming and validating.
As an aside, a friend of mine also had a horrible birth. At her 6 week GP check the doctor asked her about the birth, and she said “it was horrible and I feel traumatised”. The dr said “hmm”, and moved on to the next question, as if trauma was to be expected.
Imagine saying that in any other circumstance – imagine a doctor fobbing you off if they think you have PTSD after any other form of violence.
Anyway, I won’t ramble on, you’re far more articulate than I am, and I hope to read what you have to say on the issue one day.
Aphie – complain to me any day. It is awful, you do have a right to complain (and so do I), and eventually we will change things for other women. I have to keep believing 😉 I think it’s funny that they place all this importance on the life of the child, and so little on the mental health of the mother. There’s a connection here people!
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It’s hard to tell whether the tide is showing signs of turning in the future. In the wake of the Cochrane study endorsing midwifery-led care, the Canberra Times has published an article that (for once) doesn’t attribute automatic credibility to what’s coming out of the College of Obstetricians.
“Caesarean rate not a problem: obstetricians”
Gotta love the “only fractionally higher than Britain” – the UK rate was 23% in 2004! (Anyone got more recent figures?)
Gotta love the lines about fat, Asian, and rural women being to blame, too. Awesome.
I don’t understand how a collarbone can be snapped “by forceps” as such; however, collarbone fractures can certainly occur in births in which the shoulder birth is difficult (often exacerbated by lithotomy or semi-sitting positioning). Also, deliberately snapping the collarbone is one last-resort technique for getting a baby out when it’s stuck by the shoulders, as it’s an injury that heals very rapidly in newborns compared to brain damage.
Many births that would have involved forceps in days gone by are now done either by vacuum extraction or C section. This is somewhat contentious; vacuum cups can cause more trauma to the fetus’s head than forceps, whereas forceps births tend to involve more trauma to the woman’s perineum than vacuums.
The story has always been that the broken collarbone was accidental. I have no more information.
“Rachel: thanks very much for that paper. One of the really telling figures in it for me was this:”
Lauredhel, Yes, that is definitely illustrative of the problem in the public vs private debate. It also seems to me from that study I linked to that there is this ‘doctor knows best’ paternalism. This is neither informative nor empowering for birthing women. At the end of the day what we need is for women to be as informed as possible, and to be making birthing decisions based on the most up to date, reliable and rigorous evidence. The only way many women will be able to access this information is if their GPs and obstetricians act as the professionals they are, and are prepared to view their role in the birthing process as one of partnership with the woman and her partner (where relevant). Sadly, the evidence shows many health professionals do not see themselves in this way.
Sorry for getting back to this thread late, I hope it hasn’t interrupted the conversation.
You can’t say no to a scheduled induction without the direct risk that you will be monitored very closely by child welfare departments. All the medical knowledge won’t matter. You cannot argue when there’s wealth and prestige at stake. Scheduled induction DOES increase the risk of cesareans, and over 50% of epidural births end in cesareans. Even women in early labour are told if they are not dilating a centimeter an hour it’s cesar for them, and if you don’t consent, “welfare” for your child over-rides your lack of consent. Vaginal Examinations can and do cause your cervix to shut down, meaning you won’t make the targeted deadline. And you have no right to refuse them. When a lady is struggling to push her baby out, they rarely prop her up into a squatting position to increase her pelvis opening by 30%. They go straight for the forceps and vacuum. Requiring a HUGE episiotomy. Of which many do result in permanent damage and incontinence. I went from progressing very well to being minutes away from cesarean after labour was stopped completely for 4 hours, then I had 4 hours for labour to re-start and become fully dilated. And that was after fighting with a midwife on my side. Vanity? How is it vain to opt for an operation leading to not only massive scarring, but in many cases a fist is inserted into your vagina and the hand opened up to do their thing? Last time I checked it was easier to get a tampon out than in. And this at a time when your vagina is swollen with blood rendering you so tight a finger barely fits. How does vaginal birth put your pelvic floor muscles at risk? By being done completely incorrectly. You want to try saying “no” to these doctors/butchers? Have your baby taken from you and being labelled a radical with no concern for your baby or body? I did, and it horrifies me that I still came so close to losing my battle, and that they made my baby pay so dearly (almost with her life) for my “arrogance” in fighting for my body and baby. And Oh yes. The “horrors and agony and distress” were always mentioned when speaking to these “professionals”. Never was there a mention that when done correctly labour and birth hurts less than consipation.