PM - Thursday, 16
October , 2003 18:42:00
Reporter: Annie White
PETER CAVE: It's as old as
humankind itself, but childbirth continues to provoke heated debate
amongst health professionals, the community, and of course, mothers. In
particular, there's dispute over whether a natural childbirth, or
delivery by caesarean section, is the best or safest way.
In this
month's Australian and New Zealand
Journal of Obstetrics and Gynaecology, two doctors argue
against trials comparing the alternatives, saying the results could
fundamentally affect the very nature of giving birth.
Annie White
reports.
ANNIE WHITE: Medical science generally pushes for more
knowledge, rather than less. But in what is an already passionate area
for debate, Professor David Ellwood and his colleague, Dr Stephen
Robson, are urging restraint in the study of the relative merits of
caesarean section and v! aginal birth.
DAVID ELLWOOD: There is an
increasing trend towards elective caesarean section, and there have been
discussions over the last couple of years about mounting the so-called
term-cathallic (phonetic) trial, which would be a randomised trial
comparing caesarean section versus planned vaginal birth for women
having their first babies.
We're concerned that the impact of
such a trial could well be quite far reaching, and that it needs to be
well thought through before such a trial is mounted.
ANNIE WHITE:
According to Professor Ellwood, funding applications have been made for
doctors in the United States to conduct such a trial. His concern is
that such a study could have a serious impact on women's choice about
the type of birth they want to have.
His fear is that if
caesarean sections were found to be safer in such a trial, doctors and
patients might feel compelled to go that way.
In support,
Professor Ellwood cites a worldwide trial i! n late 2000 on the safety
of vaginal breech births, which he says has resulted in most breech
babies now being delivered by caesarean.
DAVID ELLWOOD: We
already had available quite a lot of information about the safety of
vaginal breach birth before that trial was conducted. One problem with
the outcome of such a trial is that it tends to be� the results are then
applied universally across all vaginal breech births, and there's no
attempt to individualise care, even though a number of authorities, you
know, such as the Royal Australian New Zealand College of ONG, do state
in their policies that vaginal breech birth is still a reasonable option
for some women to choose, it's a really a choice that's now virtually
denied to women.
ANNIE WHITE: Professor Ellwood says not all
studies are good studies, because the results can depend on who is
included and how it's run. As well, he says many of the health impacts
of babies and children could take as long as 20 years to show.
Dr
Barbara Vernon is the Executive Officer of the Australian College of
Midwives. Like Professor Ellwood she had serious concerns about any
moves to a randomised controlled trial.
BARBARA VERNON: Well,
studies into caesarean section that would be truly based on a randomised
basis would be highly unethical, it would involve randomising women into
having major abdominal surgery without the presence of a medical
indication that that was the best thing for them and their baby. And it
is very hard to see how it could ever be ethical to assign someone to
major surgery when there is no medical need for that.
ANNIE
WHITE: Dr Vernon says the popularity of caesarean sections in Australia
is already a cause for concern.
BARBARA VERNON: Certainly a
caesarean section is a marvellous technology, and it needs to occur for
a small percentage of women. But it is not acceptable that we have
caesarean section rates close to 25 per cent nationally in Australi! a,
when international best practice shows that 10 per cent� 10 to 15 per
cent should be the upper limit.
ANNIE WHITE: Midwife and
President of the College of Midwives, Marg Phelan, says she's concerned
women aren't being fully informed about the risks of having surgery to
deliver their babies.
MARG PHELAN: Natural birth is the best way
to have a baby, yeah, and having a caesarean section is a major
operation, it's a surgical operation, which has its own risks, any
operation has its risks for the mother and for the baby.
ANNIE
WHITE: What are the risks associated with caesareans?
MARG
PHELAN: Well, an anaesthetic for a starter, whether it be a spinal
anaesthetic or a general anaesthetic, they have a � they carry a certain
amount of risks, and an abdominal operation, interference to the bladder
or to the bowel, accidental, you know, damage to those areas, and then
of course, the risk of an infection afterwards at the wound site, a risk
of the baby develop! ing some complications, respiratory complications.
ANNIE WHITE: While he accepts that information is helpful to
both mothers and professionals, Professor Ellwood believes careful
thought is needed before we begin to ask the questions.
DAVID
ELLWOOD: It would be a very radical step to completely change the way
that women have been giving birth since the beginning of time, and
essentially what we're asking the profession to do, and this is an
article that is aimed at obstetricians, is to think very carefully about
the ramifications of such a trial before it's conducted.
PETER
CAVE: Professor David Ellwood, Professor at Sydney University and the
Australian National University and an obstetrician at the Canberra
Hospital. |
