What is Obstetric Culture?

Once a caesarean always a caesarean? You need to see a doctor? I just don't go into labour? These beliefs are obstetric culture.

What is Obstetric Culture?

Imagine a woman goes into unexpected labour and you’re the only person there who can help her. How do you see the woman? How do you see yourself helping her? Is she on her back? Are you shouting ‘PUUUUSH!”? If you are, that’s obstetric culture.

Let’s take a look at some of the obstetric culture myths that have permeated our daily lives and unrealistically altered the way we view birth.

You need to be told when to push: Women’s bodies push babies out quite effectively without ever being told to push. It’s quite incredible that onlookers think they know better than the labouring women when to push ….. that’s be obstetric culture. Coached pushing (telling a woman when to push) when a woman is unhindered is completely unnecessary and it causes complications.

Women give birth on their backs: Only in hospital! Being upright allows the pelvis to open properly and harnesses gravity to help bring the baby down. Being on your back results in  more tearing, a longer pushing stage, more pain, more assisted births (forceps and ventouse) a greater risk of haemorrhage, and reduced flow of oxygen to the baby, also more chance of  shoulder dystocia. Large babies are often removed via caesarean surgery but an upright women who is unhindered by drugs can more often than not give birth to a large baby without complications under the right conditions.  The evidence very VERY clearly shows that women should be upright to give birth and yet all the images of birth we see on television, movies, magazines, and books show women in a supine position. This position is easier for surgeons because they can see the baby emerging, but the surgeon is the only person to benefit. When women are free to move instinctively in labour and birth they VERY RARELY choose to lie on their backs. If they do choose it there’s probably a very good reason for it, but it’s not for the ease of onlookers, it’s instinctive to ease the baby out.

You need to see a doctor: Around the world most women see midwives during pregnancy and birth, and an obstetrician only if complications arise. According to the extremely well renowned Marsden Wagner

“Having a highly trained obstetrical surgeon attend a normal birth is analogous to having a pediatric surgeon babysit a healthy 2-year-old.”

When births are attended by midwives women undergo fewer interventions, and feel a greater sense of satisfaction afterwards.

I just don’t dilate: The most common reason for caesareans is Failure to Progress. It can definitely pose a problem however true Failure to Progress is EXTREMELY RARE, and Failure to Wait is extremely common. When a woman’s body isn’t ready, when the baby isn’t ready, nothing 9except a true premature birth) will  cause genuine, effective labour – not even synthetic hormones. The methods used to assess dilation and failure to dilate are outdated and are resulting in an epidemic of caesareans.

I had to be induced or I would never have gone into labour: Because all over the world – anywhere without routine induction – we can see women enrolling their bellies in preschool? In university? The risk of stillbirth increases ever so slightly as a pregnancy progresses, but there is no exact science for dating, so decisions to induce should be based on health rather than on dates. This is especially true given that 50% of women who are induced end up having a caesarean. Induction is not risk free.

Caesareans are easy: They are easy for surgeons, they are risky for women and babies. Women face risks like haemorrhage, infection, blood clotting and more and babies face risks like premature birth, injury, and breathing difficulties, breastfeeding difficulties and more. Caesareans are obviously quite safe in this day and age, and we are very privileged to live in a country where they are available in an emergency, but to promote them as the risk free is an outright lie – one of the worst lies in obstetric culture. Each time a woman has a caesarean she faces risks, and those risks increase for the next pregnancy. Risks like placenta accreta, increta, and percreta among others.  Caesareans are major surgery, they aren’t like a gallstone, they should be used sparingly if they are to more benefits than risks.

Once a caesarean always a caesarean: This was true if you lived in 1916 when this saying was coined. Back then caesareans involved cutting the woman from the top to the bottom of her uterus and vastly different stitching materials as well as techniques. These days we have multiple studies that show that, despite a very small increase in the risk of a uterine rupture, the majority of women are safer if they give birth vaginally for subsequent babies.

Woman's hands on her pregnant belly with blue beads dangling
Blooming belly.
License: Creative Commons CC0.

The way birth is shown on television and movies is an unrealistic representation of the way women give birth. It’s a fair representation of HOSPITAL birth, but hospital birth is entirely dictated by obstetrics, by making less work for surgeons who attend births, by ticking all the boxes so that staff have their behinds covered if something goes awry. The way birth is shown to us in popular culture has been created by this, but when women give birth at home birth looks quite different. Obstetrics has revolutionised the way women give birth, and not always for the best.

  • Before you make decisions for your own birth, be very clear about what part obstetric culture plays in your decisions.
  • Before you tell women about your births, be sure that you’re telling them real facts and not perpetuating obstetric myths, because the benefits of that are far greater for obstetricians than they are for women and babies. This does NOT mean that you should not tell your birth story, quite the contrary, it means that you should be absolutely certain about what happened during your births before you give other women dire warnings about what to expect. 

FOR FURTHER READING

Are Vaginal Exams Accurate? 

Maybe You Need A Caesarean, Maybe You Don’t

Can You Avoid Failure To Progress

The Great Panic To Induce

Birth Grief Is Real

Regulating Obstetrics

 

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