Elective Caesareans! From time to time someone gets a bee in their bonnet about them. The cry goes out that we must ban elective caesareans and within days, all hell ensues. Everyone seems to have an opinion on the matter, but at the end of the day, do those opinions really matter if they are not the opinions of pregnant women?
Women have so few choices when it comes to giving birth. For the majority of women, the only option is hospital or freebirth. A small number have access to, and can afford to seek the services of a private midwife, or attend a birth centre but even in those circumstances, the majority of women still appear to prefer hospitals.
When women give birth in hospital they have very similar births, despite women and their families being vastly different from one another. They involve frequent vaginal exams, IV fluid, induction or augmentation, continuous monitoring, epidurals, supine pushing, episiotomies, forceps or ventouse, and a massive one in three (often more) involve a caesarean.
Choosing to have a caesarean and bypass the rest of the hospital birth experience should remain a valid and available choice. We all know that caesareans are riskier than vaginal births, but that is not entirely objective. For women, the risk of emotional damage is a very real one, and women should be able to choose for themselves which risks are greater. Are they more afraid of bleeding to death during a caesarean, or of feeling violated by strangers in close proximity to their vagina during a vaginal birth?
When women are in possession of all the facts, risks and benefits, of caesarean surgery, very few of them would prefer a caesarean to a vaginal birth. However the word “elective” conceals a few home truths. Often an elective caesarean is pushed by the doctor without full disclosure of all the relevant facts.
Any pre-booked caesarean is classed as elective, and no further information is given about whether the woman herself wanted the surgery, or whether she was advised that it was necessary by her surgeon, and indeed whether she was told about any other options she might have.
Some surgeons claim that to deny women elective caesareans is anti feminist, but when we look at the huge numbers of surgeons who deny women breech births, and vaginal births after caesareans, that excuse looks quite flimsy.
Politicians and policy makers sometimes claim that elective caesareans cost too much money, money that could be better spent on other areas of health. However they don’t make the same claim about inductions, which frequently lead to caesareans. This is probably because the medical lobby groups support obstetric practices, and politicians tend to leave it to the “experts”.
Some people claim that caesareans are damaging to both women and babies and should only be performed when all alternatives are exhausted and the benefits outweigh the risks. Whatever the reason, the result is the same. Women who wish to access an elective caesareans become political pawns in a game of chance.
It’s arguable that when women are in possession of all the facts about caesareans, very few of them choose one, and that some of the women who do opt for an elective caesarean, do so out of poor advice and support from families and care providers. So those who are opposed to elective caesareans should seek to inform women, rather than seeking to further limit the ways in which a woman might welcome her baby.
Until such time as we can offer women access to all the possible choices for birth, including VBAC, waterbirth, midwifery care in and out of hospitals – not under the oversight of surgeons, specialist surgeons where necessary, birthing centres, and breech births, we can not diligently remove any choices from the table.
In terms of physical health, unhindered vaginal birth is unquestionably superior to a caesarean, but women are not just physical beings. We need to create a cultural shift, a holistic approach to birthing options that takes into consideration the woman’s mental and emotional well being, personal preferences, history, and of course her physical health and that of her baby. Women must have access to a wide range of choices for birth. The work of birth activists must be to increase choice, not to limit it as obstetric culture has done so effectively. It is vital that we not limit birthing preferences because it is in part, the limited nature of choices we currently see, that results in women setting physical safety aside, and preferring caesareans to unhindered vaginal birth.
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