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,...
Read MoreMy First Unnecesarean
When I first became a doula I was quite naive. Yes, I had been given all the information and statistics during my training but there was a part of me that smugly believed I could ‘save’ any birthing situation with good intentions, homeopathic remedies and aromatherapy oils. *humble blush* I attended my first unnecesarean very soon after becoming a doula. I met with a young couple who were keen on a natural birth but in hospital. She had originally wanted a home water birth with midwives but he did not trust midwives and therefore they had chosen a female doctor who seemed to resonate with the young woman’s wish to birth physiologically. They had chosen (or rather, their medical aid had chosen) a hospital which was nicknamed Caesar’s Palace due to its alarmingly high c-section rate (anywhere between 80 – 100%). We went through their birthing plan, which was beautiful, and it was decided that I would join them at home in labour and that we would go through to the hospital once labour was strong and well established. They felt optimistic that with the birth preparation they had done attending an antenatal class and with the support of their doctor and myself, their birth plan would be successful. Simple right? They called me one early morning to tell me that her waters had broken and that the doctor had told them to come in to hospital as she needed monitoring. They would keep in touch with me. Luckily for her, her contractions started soon after her waters had broken and when I arrived at the hospital, she was already contracting regularly. I was taken aback by what I saw though, she was in a hospital gown (her birthing plan had explicitly expressed that she labour in her own clothes) and she was attached to a drip which was administering antibiotics (to ward off infection now that the waters have broken, I was told). Despite these obvious discomforts, this young woman used the breathing techniques she had learned and practiced in her antenatal classes and walked about the room, pushing the drip stand around as she laboured. At least she was not continuously strapped to a foetal heart monitor, but she did have to lie down every hour for twenty minutes or so to be monitored which was extremely uncomfortable for her. At one point a doctor came in to examine her. It was not the doctor she had built a relationship with, her doctor was unavailable and this new doctor (all in black and wearing a pearl necklace) would be taking care of her. My client tried to hide her disappointment and muttered that at least the new doctor was female. The new doctor examined her patient and declared that my client was already 4cm. The doctor congratulated my client on her progress and said she would be back in a few hours to check on my client again. We were pleased and for the next four hours, as the contractions grew stronger, the young woman continued to use her breathing techniques, and walked about the room listening to the music she had so carefully chosen for this special event. I rubbed her back and chatted to her husband who was sweetly supportive. A nurse came in every half hour or so and monitored the baby’s heart rate, checked her blood pressure and took her temperature and pulse. Labour seemed to be progressing, we were feeling positive. At one point I excused myself and went to the en suite loo. I heard the doctor coming in and when I came out of the bathroom...
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