Two weeks ago I wrote about the first unnecessary caesar I attended.
It was the first but it was also not the last. It did prompt me to do my homework and to really make sure that the women I was attending as a doula were well informed.
One of the things I did was call up all the maternity wards of all the private hospitals here in Cape Town and ask them directly what their their caesarean section rates were. I knew from discussions with other doulas and midwives that many caesars were taking place but I did not have clear numbers.
The conversations went something like this:
“Hi…I am a doula supporting mothers wanting to birth vaginally in private hospitals here in Cape Town and I would just like to know what your caesarean rates are so that they can make an informed decision about where the best possible place to birth is.” Or something along those lines.
Responses were everything from helpful and obliging to irritated, rude and irate:
“Oh one doctor here has about a 60% caesar rate…he really tries, but the others are definitely around 80 – 90%”
“About 65% but I think it is the private midwives that do deliveries here that bring the rates down…the doctors have much higher rates than that.”
“Between 60 and 90%.”
“I don’t see why we should divulge this sort of information, I don’t see how a high caesarean rate can make a difference to a woman’s chances to birth naturally!”
“It is definitely upward of 80% but I am not telling you how much higher – I don’t think it is any of your business!”
So in private hospitals in Cape Town, we are looking at a caesarean rate of 60 – 90%. And from my experience in two of the major government hospitals in Cape Town, it seems to be around 50% in the public sector.
The World Health Organisation recommended a caesar rate of between 10 – 15% as being healthy, so WHY is our caesarean section rate so high? And why is it not my business to find out the caesarean rate of a hospital that is often promising to be supportive of women’s wishes to birth as they wished?
And why is it suddenly okay to slice open perfectly healthy women and change their obstetric history forever?
(I need to stress that I am not anti caesarean. I am eternally grateful for the operation that saves the lives of mothers and babies. I am not putting down this very necessary intervention and the skilled people who can perform it.)
Since then I have worked within home birth midwifery practices and met midwives from all over the world who maintain a caesarean rate of between 2 and 20 %.
Why do they get it right and the hospitals do not?
I think the saddest and hardest thing for me is meeting the women who have undergone these unnecessary caesars. Who come with their stories. And who really want to give birth vaginally this time around, sometimes after one, sometimes after two, sometimes after more caesareans…
I was induced at 38 weeks and didn’t progress so I had to have a caesar.
The doctor said my baby was getting to big and I would never be able to birth her – but then she was an average size!
I had a supportive doctor but she was on holiday when I went into labour and I got the doctor with the highest caesar rate in the hospital.
The environment was too clinical for me, the beeping machines, being strapped down and checked constantly definitely inhibited my labour, I just could’t dilate in that environment.
My amniotic fluid was too high.
My amniotic fluid was too low.
My baby was posterior.
I took too long trying to push the baby out.
I was told at my first appointment that my feet were very small and that I would probably end up with a caesar.
The placenta was calcifying.
I could feel there was no support in the room for a natural birth – so I gave up, I went for a caesar…I could feel they were all just waiting for me to throw in the towel.
The list goes on and you begin to see a general theme developing. The same stories begin to repeat themselves and the women sitting there telling the stories all feel robbed of an essential experience.
And who is there to take care of them? Who is willing to take the risk and attend a woman attempting a VBAC (Vaginal Birth After Caesarean)? Because now she is no longer a straightforward, ‘low-risk’ woman, now she is labeled as ‘high-risk.’
Who take this risk?
Some doctors do, yes.
But often it is midwives who take this on. Because they hear the stories and they know in their gut that this woman can birth this baby the way she was meant to. These midwives strongly resonate with the woman’s need and want to assist.
And often, after a previous negative hospital experience, women seek the one on one care from a woman who seems to understand her, hear her and believe in her.
But there is little support for midwives attending women with previous caesars and it is becoming harder for them to do so, with doctors and hospitals pulling back and removing their support of midwife assisted VBACs.
But what do we do?
What do we do about this sudden epidemic of high risk women?
Midwives cannot carry this alone. Mothers need to step in and make sure that firstly, these unnecessary caesars are stopped, and secondly, that women seeking VBACs can find sympathetic and supportive caregivers.
We continue to support them.
Because you know what?
VBAC has two meanings:
1. Vaginal Birth After Caesarean
2. Very Beautiful And Courageous
And there is nothing like being part of the healing that takes place when a woman achieves this triumphant goal.
So let us not take it away.
