C-Section rates: Are they the real problem?

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OK. Before I start this post I guess I need to say that I post this as a genuine exploration of the issue. I would love for people to share their insights and experiences on this. You will not be censored, but do try to actually read what is being written.

OK.

(cracks knuckles)

I have been thinking about this “too many c-sections” issue for some time. An example of the “outrage” is HERE

I have read recent articles where certain lobby groups, the medical fraternity, and other interested parties are actively campaigning to reduce the number of c-sections, using the argument that c-sections are unnecessary and dangerous.

But are c-sections the real problem here?

In any society, especially one as rich as ours, there will always be those who elect to have a caesarian. Their reasons are their own and I respect that. There are also those who will advocate a completely natural birth and often the two “sides” will clash over the issue. Somewhere, along the line, the real cause of traumatic births, c-sections and higher neonatal risk seems to get away unscathed.

The real culprit? Labour inductions. And who is to blame? Those who support induction as a routine end to a pregnancy, or as a safer alternative to a caesarian section.

Let me explain.

What people seem to ignore is the role of routine induction of labour and its role in unwanted and probably unnecessary emergency c-sections. Women who are induced have double the chance of an emergency caesarian as women who go into labour spontaneously. They are also at higher risk of other interventions like forceps, which put the baby at risk.

I’ll share my experience briefly. I was pretty raw about this until recently, but I was induced with Mina because of Pregnancy Induced Hypertension (PIH) and, worse, Symphysis Pubis Dysfunction (SPD) which made it unbearably painful to walk.

In retrospect, I have to admit that I made an ill-informed decision. My obstetrician did not inform me of the risks, nor of the fact that I would have double the chances of a c-section. He did not inform me about the Bishop Score, or that my labour had a high risk of failing to progress because of my posterior baby. I ended up with an emergency c-section after 36 hours of labour, a cracked rib and a fucked up pubic bone.

In hindsight, I probably would have waited, or stayed on bedrest. And, if the PIH had gotten worse, I would have had an elective c-section. Who knows if things would have gone differently if I hadn’t been induced… it might have, but, had I known of the risks, I probably wouldn’t have had a birth that traumatised me to the point of needing counselling during my second pregnancy to be able to deliver my son. I won’t go into many more details because a lot of it still upsets me, but I figured I needed to share this to give context.

As the years went on, I saw and heard about this happening. A lot. Girls who were barely over 41 weeks and “overdue” going into an induction with no idea. Then, hearing that they ended up with a c-section and were traumatised. Or, women who were being induced for social reasons, ending up with c-sections. Or, women who have some sort of health problem that meant they needed to be induced — ending up with a c-section anyway. And being shattered by it.

What’s my point? Well, I have a controversial idea.

To reduce the rates of “unnecessary” c-sections, reduce the rates of “unnecessary” inductions.

Of course, this excludes women who want to have an elective caesarian for whatever other reason. Just stop bullshitting women and telling them that an induction is going to work, or that it is “safe”. Stop bullshitting women who are 3 days over their due date and stop telling them that they are “overdue”. Not only do inductions NOT work, they seem responsible for the great majority of traumatic birth experiences that include emergency c-sections, as well as forceps, ventouse and other traumatic interventions. Women need to be armed with knwoledge about their Bishop Score prior to undergoing induction, and Doctors need to be candid about the fact the inductions probably won’t work.

My opinion?

I can hear you gasping. I know. But hear me out.

Most inductions fail in some capacity. They are promoted as a routine part of childbirth, when they are NOT. They are dangerous, and, for convenience deliveries or minor ailments/discomfort, if a woman’s only options were a c-section or a natural spontaneous labour, you would find that many would opt to wait for the labour. And often, with social inductions, the Bishop Score is lower and the induction is most likey to fail — and they need to be informed of this. For genuine emergencies like severe preeclampsia or foetal distress etc, don’t put a pregnant women through any more stress than necessary. Give them a c-section — they’ll probably end up with one anyway!

Our primary goal should be about getting rid of the source of trauma and difficulty for women having babies, and considering not only the physical risks to mother and baby, but the emotional ones as well. C-sections aren’t the problem. Inductions are. And if we reduced the number of routine inductions and put tighter controls over their application, we would find that, over time, the rates of “unnecessary*” c-sections would reduce.

*This excludes c-sections that are elective and are done by choice. I respect a womans choice to choose how she gives birth, either naturally or via c-section, but inductions are the real problem here, and lead to UNWANTED c-sections.

Discuss.

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