Childbirth is a very natural process that nature has successfully refined through tens of thousands of years. The knowledge of how to give birth has passed down through generations in our genes. Childbirth should thus be the same for today’s modern woman as it was for a woman living in a tropical jungle thousands of years ago.
But for a growing number of women today, the experiences of pregnancy and childbirth are riddled with feeling of fear, doubt and anxiety. The reason: doctors today treat birth as if it was an illness – and pregnant women are treated like sick people.
Most pregnancies and births today are medically managed. As childbirth increasingly “requires” medical intervention, most women “give up” responsibility for childbirth rather than “going along” with the process. Pregnant women thus inevitably go through a medical experience – from the time a woman discovers she is pregnant to the day her baby is born and even after that, she is subjected to routine use of technology in a laboratory setting.
In hi-fi obstetrics care, pregnancy is seen as a “risky condition” that requires medical intervention. The modern management of pregnancy and birth has, in fact, been described as “prenatal care that expects trouble”. As a result, women today have come to believe that childbirth is too dangerous and painful to endure without doctors and hospitals.
Childbirth today has become so increasingly influenced by medical technology that in most Western countries, medical intervention is now the norm. Young women in these countries end up learning attitudes about childbirth that are not positive. They grow up fearing and not understanding the whole process of having a baby.
But what is of greater concern is this: according to some obstetricians, birth today has become too medicalized – at the expense of both mother and child. One worrying aspect is the caesarean section, a major abdominal surgery for childbirth.
Over the last four decades, the rate of unnecessary caesarean births has grown in alarming manner and gynaecologists, obstetricians and healthcare administrators throughout the world have not managed to slow it down, notes The Lancet, one of the most respected medical journals in the world, in its 3 June 2006 issue.
In many countries with high caesarean rated today, experts believe the surgery is an unnecessary intervention in an increasing number of modern-day births.
The World Health Organisation (WHO), which charts global health trends, has been sounding the alarm on the caesarean trend, citing statistics that show the number of caesarean sections in developed countries has been on the increase in recent years, and is often performed for non-medical reasons.
Risks for baby, risks for mother
A caesarean section, or a c-section, is major abdominal surgery where surgeons make a series of separate incisions in the mother. Cuts are made in the skin, underlying muscles and abdomen first, and then in the uterus, to allow removal of the infant. Like all major surgeries, there are risks involved in this case, to both mother and the new-born.
Babies born by caesarean not only don’t have the benefit of labor, which squeezes fluid out of the new-born’s lungs, stimulates the baby’s ability to regulate body temperature, and may promote the release of hormones that encourage healthy lung function, they face serious risks to their lives, too.
Risks for the baby include the following:
- Premature birth. In a planned C-section, if the due date was not accurately calculated, the baby could be delivered too early. Removed too soon by caesarean, the baby can suffer respiratory distress syndrome, transient tachypnea (abnormally fast breathing during the first few days after birth) and other lung disorders, feeding problems and various complications, which in some cases, require a long hospital stay;
- Foetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision; and
- Death. Infants are more likely to die from a caesarean than vaginal birth.
Risks for the mother are also grave:
- Infection. The uterus or nearby pelvic organs, such as the bladder or kidneys, can become infected;
- Increase blood loss. Blood loss on the average is about twice as much with caesarean birth. However, blood transfusions are rarely needed during a caesarean;
- Reactions to anaesthesia. The mother’s health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anaesthesia or other medications during the surgery;
- Risk of additional surgeries – eg: hysterectomy, bladder repair, etc.;
- Blood clots in the legs, pelvic organs, or lungs;
- Bowel or bladder injury; and
- Respiratory complications. General anaesthesia can sometimes lead to pneumonia.
Caesarean, though useful in warranted cases, is thus a risky operation that should be avoided in normal, healthy pregnancies.
Yet, today birth by c-section has reached an all-time high. In some countries today, it is even being offered as a choice for childbearing women to deliver their babies, of what is known as elective caesarean.
How common is the caesarean culture? Let’s look at the statistics.
Sky-high rates
The WHO states that no region in the world is justified in having a caesarean rate greater than 10-15%. These are the optimal levels for the best outcomes for mothers and babies. Any country with a caesarean rate above 15%, according to the WHO, should be looking at the reasons why.
Yet in countries with modern health care systems, the rate of caesareans is many times higher than this.
In Australia, about 40% of all births are caesareans and some medical experts believe they will soon become the norm. David Ellwood, a professor of obstetrics and gynaecology at the Australian National University suggests 90% of births in Australia will be via caesarean within the next 2 decades (The Daily Telegraph, 11.3.07).
In Brazil, caesareans account for nearly 40% of births, three times the maximum limit of 15% recommended by the WHO.
According to 2001 figures, more than 36% of all births here are by caesarean section; many private hospitals report rates in the 80-90% range.
In Italy, the rate is reported to be 32.9%.
In the US, the caesarean rate was 30.2% in 2005, up from 26% in 2002. The caesarean rate here has in fact, risen 46% since 1996. There were 1.2 million caesarean births here in 2004 alone.
In Canada, the rate was 22.5% during 2001-2002.
In the United Kingdom, the caesarean rate was about 20% in 2004. Today it has risen to above 23%.
The high rate of caesarean sections in most western countries is now regarded as a major public health problem and has spawned much discussion, numerous publications and meetings, and varied recommendations (study in Social Science Medicine, 1998).
The same trend has also been noted in other non-Western countries.
Nigeria is reported to have a caesarean rate of 34.6%.
Asian countries seem to be headed the same way, and from the statistics, the situation could be worse here.
In China, the ratio of caesarean births has soared to 50%, from a mere 5% in the 1950s-1970s, far exceeding the standard of 15% set by the WHO (Xinhua Economic News, 15.2.07). Some urban hospitals have a c-section rate of more than 60%!
In South Korea, it is reported that caesarean section rates for 263 hospitals there were 45.9%, 42.7% and 44.6% in 1999, 2000 and 2001, respectively – rates that surpass those of western countries and that are also higher than the WHO recommendation.
In Thailand, the caesarean rate is reported to have increased, form 15.2% in 1990 to 22.4% in 1996.
In Singapore, it is reported that 31% of women who gave birth in 2003 had a caesarean, up from 24.5% a decade ago.
In Malaysia, official figures are lacking, but from statistics in the few available studies on maternal complications and deaths reported, child-bearing women are also exposed to similar risks. Utusan Konsumer
