By Danielle Teutsch, Health Reporter July 7 2002
The Sun-Herald
Women fearing pain and concerned about their baby's health are forcing
obstetricians to perform caesareans against their will, childbirth experts
warn.
The trend has led to an alarming increase in requested caesareans and
obstetricians are caving in to the demand because they fear being sued,
professor of obstetrics and gynecology at NSW University and the Royal
Hospital for Women Michael Bennett said.
"Women are coming in and saying, 'We don't want to take any chances at
all with our babies'," Professor Bennett said.
"We have lawyers, company directors, women in positions of power and
influence who are having babies later. And in this present medico-legal
climate, the average obstetrician is going to cave in and say, 'Yes, OK'."
Dr Tony Frumar, an obstetrician at Prince of Wales Private Hospital and
King George V Hospital, said women were scared into requesting caesareans
after hearing "war stories" of traumatic vaginal births from other women.
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"It's mainly because they are frightened of labour," he said. "There is a
fear of damage to the baby and to themselves."
St George Hospital obstetrician Dr Greg Davis agreed the rate of elective
caesarean deliveries had risen but said it was more marked in the private
sector.
The latest caesarean section statistics from the NSW Midwives Data
Collection, from July to December 2000, show rates to be above 30 per cent at
some Sydney private hospitals. The overall rate for NSW hospitals was 21.8pc.
There is no data on how many women requested the caesarean as a personal
preference rather than a medical necessity.
Dr Frumar put the request rate from his patients at 10pc.
Dr Norman Blumenthal from The Hills Private Hospital said it was not just
older mothers driving the trend.
"The age is becoming younger and younger," he said.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
spokesman Dr Andrew Pesce said he was unsure why there was a public perception
that caesareans were safer.
"Very rarely, there are complications during natural childbirth that could be
avoided by a caesarean," he said. "But there's little doubt there's an increase
in the complication rate for the mother [with a caesarian]."
He said fear of childbirth was certainly an issue for first-time mothers.
"Maybe taking a decision to have an elective caesarean restores their dominance
over the process," he said.
Other reasons cited by expectant mothers for wanting a caesarean included
concern about damage to the vaginal tissue and pelvic floor, and urinary
incontinence later in life.
Professor Bennett said he believed the pendulum still had further to swing
before the trend to request caesareans abated.
"It's ridiculous to think that mother nature would design a system so faulty
that one in three women would need a caesarean," he said. "It is not a risk-free
procedure."
Taking the gain without the pain
Having a natural delivery was never an option for first-time mother Louise
Lister.
The 34-year-old photographer from Enmore said her main object was to "get the
baby out", and minimise pain.
"I was pain averse, first and foremost," she said. "I had had a bad
experience with pain in the past where I had fainted, so I didn't have any faith
in my own body to deliver the goods in a natural birth situation.
"I welcomed medical intervention - I had never felt the desire to have a
natural birth."
Ms Lister said there were clinical reasons why a caesarean was justified, as
she had had cervical cancer and there was a possibility she would have trouble
dilating.
"I thought there was the potential for the baby to become distressed if there
was a long period of non [cervical] dilation," she said.
Her family and friends had supported the decision. Only a few people who did
not know her well had viewed it as a "cop out".
Ms Lister said that although the caesarean birth of her son Oliver on Friday
was "traumatic", she had no regrets. The only downside was the lack of recovery
time with the demands of a newborn baby.
"If I did it again, I would go the caesarean option," she said.
Operation downside
Women who give birth by caesarean section could be delaying their chances of
having another child, researchers warn.
Scientists from the University of Bristol in England have discovered that
women who take a surgical route are almost twice as likely to take longer to
conceive again.
The research, published in the journal Human Reproduction, found 12
per cent of women who had a caesarean took more than a year to become pregnant
again. The rate for natural-birth mothers was 7pc.
Dr Deirdre Murphy said: "Women who have caesareans also are more likely to
have an ectopic pregnancy or miscarriage when they next become pregnant."
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