Are We Creating an Epidemic of High-Risk Women?
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,...
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