Thought folks might be interested in three responses from the australian feminists political list to the RCT issue. I posted the information there to see how mainstream feminists view this issue. It is fascinating how people think about things.
warmly, Carolyn Hastie Subject: Re: ausfem-polnet Randomised controlled trial Yes, I agree, it sounds totally unnecessary and fairly horrendous! The proposed research seems to be in the class of having a randomised food delivery trial for feeding citizens through a tube and through normal oral eating to find out which is better. Barbara Subject: Re: ausfem-polnet Randomised controlled trial Seems to me that if research is likely to show that natural childbirth is the safest method, that Dr Ellwood and others wouldn't feel so threatened by these kinds of studies. I also think that there are some misconceptions about the caesarian method: antibiotics are not routinely administered post-operatively; hospital stays are generally not much longer at five days or two days for "early release" (compared to three days and one day respectively); women are able to choose to have caesarians through the public system (they currently occur more frequently in the private system at present because it is doctors who influence women's "choices"); and it seems that the cost to the health system would not be higher with a half hour operation than the many hours - or days - of attendance by professionals at a natural, hospital childbirth. (Personal experience makes me confident about the accuracy of the first three of these statements, the last is me theorising!) I also think it is likely that complications from caesarians mostly occur in cases where there is an emergency operation after the mother has already started labour. In terms of likely complications, of course there are always risks associated with surgery. There are also risks associated with natural childbirth. Recovery periods also vary greatly, and this may also depend on whether it was an emergency caesar. I've had two caesars and had no problems with recovery. There was very little post-operative pain (admittedly the morphine probably helped!), was able to drive myself home on day five and return to full time work after two weeks. The issue of the dangers of going to a hospital also need to be separated out from the issue of caesarians for as long as it is still the usual practice for women to go there, regardless of the method of childbirth. While everyone has views on which is the best way to give birth, I just don't understand why there is so much opposition to research that attempts to establish which method is more or less dangerous? --- Julieanne wrote: > At 12:54 PM 17/10/03 +1000, you wrote: > > What I find puzzling is why they would need to do > more research, the > literature is overwhelmingly flooded with decades > worth of similar studies. > The facts are known and statistically proven a > hundred times over, but it > seems that every couple of years they keep doing > more and more studies to > come up with the same results. Maybe if they do > enough, eventually they > will come up with the preferred answers :) > > The acceleration in Caesarian rates has been of big > concern in all Western > OECD countries throughout the 90s, Australia has > accelerated more than most > since the mid-90s, and we now beat America, and only > 2 countries beat us - > Brazil and Mexico. > > The irony is, the USA has a national policy > instituted in 2000 to reduce > their national Caesarian rate below 20%. > > Ditto in the UK. > > The World Health Organisation has stated that > Caesarian rates between > 10-15% should be the acceptable range in Western > countries. They stated > this in 1989, 1993 and repeated it yet again in > 1998. Most of Western > Europe is the range of 10-15% > > Meanwhile Australia is pushing 25% national average, > and much of that > increase in the last 5 years. But it varies a lot, > with QLD pushing over > 30%, and 35% in private patients, ranging down to > 18% in Victoria. > > As for health outcomes, there has never been any > proven statistical > difference between the health outcomes of the > babies, when major criteria > are matched. Also depends heavily on what you are > comparing - there is also > a difference between 'elective' and 'emergency' > Caesars, and general health > status and health outcomes of different populations. > Ideally your study > populations should be matched for criteria such as > age, socio-economic > status, number of previous children, previous > pregnancy histories, smokers, > drinkers, educational status, general health and so > on. Indigenous mothers > have appalling rates of low-birthweight and sick > babies, regardless of > whether they are birthed by Caesar or not. > > As for the mothers, surgery always carries a higher > risk. Any surgical > procedure carries risks inherent simply because it > is surgery. > Post-surgical infection rates are of concern. To > prevent this, patients are > treated with high doses of heavy-duty antibiotics as > a prophylactic - not > only an increased cost to the PBS, it carries a > significant population and > public health risk due to the increased likelihood > of microbial resistance > circulating in the population at large. > > Hospitals are not healthy places, they tend to be > full of sick people. > There is a significantly higher health risk just > being in the building. > With Caesarians, there is a longer recovery period > both in the hospital and > at home, with reduced mobility and physical function > impairment. There is > an also an increased risk with every medication, > potential reactions to > anesthesia, and DVT and PE from blood clots are > common enough from any > surgery, and very much a known and appreciable risk > - the list goes on - > all of which add up on the bill both financial and > to general health status. > > And they want to study it yet again? They might > promote the "safety" of > Caesars, simply to push up the rates of income > generation. Caesarians, > particularly as private patients cost big $. If you > look at the difference > between private and public in Australia - huge > difference - private > patients get sliced up at 3-4 times the rate of the > public patients. > > I have a suspicion that the argument for Caesars > being about "choice" - is > more about choosing expensive cosmetic surgery, and > the convenience of some > women and/or their doctors, and mostly at tax-payer > expense. > > -- This mailing list is sponsored by ACE Graphics. 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