Casesareans chosen without discussion
Jan Cornfoot
Friday, 25 January 2002
Dr Shroot (Letters to the Editor 24/1/02) says that "Obstetricians do not intervene for other than good, sound, medical reasons (with the exception stated above)".
After nearly 30 years as a consumer advocate, what I'm hearing is that many caesareans come under the sorts of exceptions he mentions, ie no legitimate medical reason, but women whose fears are not allayed by the obstetricians.
An elective caesarean is frequently chosen without appropriate discussion. There is also the option of referral to someone who might assist the woman overcome those fears.
For women having a caesarean birth, the vast majority will then be unable to find a practitioner for a subsequent vaginal birth.
Jan Cornfoot
Consumer representative, Qld Nursing Council and formerly consumer representative, Qld Council of Obstetric and Paediatric Morbidity and Mortality.
Medically assisted preferable
Ann-Marie McNess
Friday, 25 January 2002
Few could sensibly argue that a natural and uncomplicated childbirth is not the preferred outcome for pregnant mothers, however my own experience indicates that this preference can shift dangerously to a priority - even in inappropriate circumstances.
Healthy and enthusiastic, I opted for a natural approach to the birth of my son, nearly two years ago.
I was as surprised as anyone that my baby was eventually delivered via an emergency caesarean section; surprised and very grateful.
I had endured a 36-hour labour, including 12 hours of chemically-assisted contractions, which had achieved almost no descent of my baby through the birth canal despite several hours of full dilation.
A number of people I have spoken with, both professionals and the lay alike, agree that this unwarranted and fruitless perseverance with the natural-birth paradigm would almost never happen under expert obstetric care, and that it unnecessarily endangered both my own life and that of my baby.
My caution, then, is around the early identification and resolution of complicated labours - even when the mother is young (-ish), fit and informed and the baby has grown well and the heartbeat is strong.
In my own case, the complication probably surrounded an unusually small pelvic structure, however the upshot is the same regardless of the detail - surely a small proportion of medically/surgically assisted births is inestimably preferable to a dangerous persistence of a morally-tinged and over-applied natural-birth ideology.
