Caesarean study challenges 'too posh to push' perception
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46 per cent of women surveyed said they were concerned about the risk to the baby. (Getty Images: MN Chan, file photo)
A new study is set to ignite the debate over elective caesareans versus natural births, with a majority of women saying they only choose surgery because of their fears about risks to the baby.
The study challenges the perception that women who choose caesars do it for more personal reasons.
Naomi Cescotto was 37 when she had her first child eight years ago.
"My mother was enormous when she had my brother, she was 29 and he was 11.5 pounds and he basically wrecked her," she said.
"My gynaecologist and obstetrician kept saying to me, 'Oh it's going to be a big one, you're a big girl,' but I got more and more terrified and I proposed the idea of an elective caesarean."
Ms Cescotto had another two children.
"If I'd thought about it more I might not have made that initial decision to have a caesar but all I could think was I want to get this baby out safely and with minimum damage to myself," she said.
The Australian College of Midwives says about 75,000 women are having caesareans each year in Australia.
'Too posh to push'?
A study published in the Australian and New Zealand Journal of Obstetrics and Gynaecology says most women who choose a caesarean birth without any medical need do so because they are concerned for the health of their baby and fears about incontinence, damage to their vagina and labour pain are down the list.
The study's author is Dr Stephen Robson from the Australian National University's medical school.
"Forty-six per cent, almost half the women, said they were concerned about the risk to the baby," Dr Robson said.
"The next thing down the track was pain at about 11 or 12 per cent, so it was absolute daylight between that and the sort of next common reason on the list."
Seventy-eight women were surveyed, all private patients. Three-quarters of them were first-time mothers and one in five had used IVF.
Dr Robson says there may be many perceptions about women who elect to have caesars, but there has been very little statistical evidence on their reasons.
"I know that's a very, very common criticism, nobody really knows the true number of caesarean sections done because women want to avoid labour," he said.
"My feeling is, speaking to women, is that the 'too posh to push' thing would be very uncommon and I think most women have apprehensions, concerns that they want to discuss and talk through and really want the opportunity to make an informed choice and not be pressured one way or the other into making any sort of a decision at all."
- Adapted from a story first aired on AM, September 25.
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Comments (44)
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dragon:
25 Sep 2008 1:57:19pm
The blame should also be shared by the Obs. Ours kept 'egging' my wife on to have a caesar. He never admitted it, but we got the impression he had a schedule to keep up to and wanted to plan his leave. Sure enough, when the day came, he was on holidays and his partner had to deliver the baby naturally ! A healthy 8.5 lbs girl :)
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shayne:
25 Sep 2008 2:45:33pm
"blame"????
Your body, your choice - I don't understand the debate other than to determine whether or not ALL the information needed for the MOTHER to make the decision has been made available.Agree (0) Alert moderator
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Si:
25 Sep 2008 2:03:29pm
So the mothers-to-be are concerned for their babies. That's perfectly natural and understandable. But what the hell are the doctors doing, who should be reassuring the mothers and giving them the facts? Ceasars are much easier on the doctor than the mothers or the babies ...
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bob:
25 Sep 2008 2:40:31pm
And possibly a little more profitable, just a thought from a skeptic
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Pun Gent:
25 Sep 2008 2:04:03pm
People lie in surveys, I think you need to look at these figures with a hefty pinch of salt.
I'm not saying that nobody who opts for a C-section does so primarily for concern for the child, but I don't see how asking people to give an excuse for their Caesarians is all that valid as a "challenge to the perception"...Agree (1) Alert moderator
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Tan:
25 Sep 2008 3:25:35pm
While I agree surveys should be taken with a pinch of salt I am not convinced doctors are giving mum to be excuses. After all until we have a child we can't know what it feels like and what may trigger that decision. We can make assumptions what decisions we would make change but that may change once you have a child.
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mallory:
25 Sep 2008 2:06:39pm
Obs definitely have a part. There are exceptions, but most are far more comfortable with the surgical route as they no longer have skills to assist women with birthing babies in certain situations, such as breech presentation. They are after all, surgeons.
I always hate hearing about women choosing c-section as the "safe" option. Given that a few studies have shown that maternal and baby mortality rates are both doubled by an elective-c-section compared to birthing "down the shute", it is far from the "safe" option. But how many obs advise their patients of these statistics?Agree (0) Alert moderator
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stuart keynes:
25 Sep 2008 3:16:54pm
"They are after all, surgeons".
No, they are not. They are obsetricians. Part of their training is surgical but they are not members of the college of surgeons. They are trained in all aspects of obsetrics and that includes vaginal deliveries and caeseran sections.
And who says they no longer have skills in breech presentations? Do you think that has been cut from the training curriculum?Agree (1) Alert moderator
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mallory:
25 Sep 2008 3:25:35pm
Lack of experience. If you research, you will find only a handful of obs in Aus will attempt a vaginal breech delivery. Many midwives will as they have far more practical experience with it. Why don't the obs have the same experience? Because they are performing c-sections instead! As I say, do your research, you will find this to be fact.
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Live and Let Live:
25 Sep 2008 2:08:18pm
My wife had to have an emergency caesar for our first child at 39 weeks as her liver was failing. Despite this not being her choice, she struggled afterwards because she had not given birth "properly" and therefore failed one of the tests of motherhood. Determined not to have another caesar at 38 weeks (when scans showed all to be fine), our 2nd child died in the womb at 40.5 weeks - no cause of death found.
Our 3rd and 4th children came by caesar at 37 weeks.
Though I never thought the "too posh to push" argument was valid, whose business is it anyway, other than the parents of the child and their doctor.
Its about time people stop being judgemental and putting undue pressure regarding what is the "right" way to give birth. From painful experience, the "right" way is the one which ends up with the mother and baby alive and well.Agree (3) Alert moderator
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S:
25 Sep 2008 2:47:18pm
A recent major study has conculded that one of the risks of primary C/S is unexplained stillbirth in subsequent pregnancies.
Your story is tragic but a very real occurrance for a lot of people. and while i understand the reasons you probably choose an early birth for your subsequent children; babies born at 37 weeks have significantly higher risk factors, including death, that are associated with C/S.
your family is very lucky to have 3 healthy children and a healthy mother to care for them, you may not think so, but you are.Agree (0) Alert moderator
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MuminCanberra:
25 Sep 2008 2:09:02pm
I had an elective cs for my first cause I was talked into it by my Dr. At the time my little darling was refusing to engage. Had I known then what I know now about how some babies don't engage until they are ready to be born, I probably wouldn't have had it. My second was twins who were both 8lb at birth and I was not allowed to have a natural birth, due to the scaring from the first and the size of the children.
The fact is, anyone who says it is the easy way out, has never had one. This is major surgery and has all the complications of that. It wasn't a spur of the moment decision. I agonised over it and it was the argument that my son could have been breach and therefore be placed in distress that settled it for me. There are many risks involved in a CS, both to mother and child. Then there are all the after affects and healing that has to occur. Many of my friends that had natural births were up and around a lot quicker than I was. I feel insulted when people imply I took the easy way out!Agree (0) Alert moderator
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Beckster:
25 Sep 2008 3:24:20pm
You're very right when you say that it's not the easy way out! I had a natural birth for my first - and even at 36 was out of hospital the next day. My second was an elective c-section as my OGYN was unwilling to allow a natural labour due to my bub being a footling breech, who wouldn't even turn with help! I was in hospital for 5 days, and sore for months. In actual fact it's taken me 10 months to start to feel like myself again.
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Felix:
25 Sep 2008 2:09:47pm
Surely it's a personal choice? In all honesty, I'm pretty sure I'd look at the surgical delivery option too! What right do any of us have to determine how someone esle should give birth? People should be concerned about their own lives instead of interering in the decisions and choices of others.
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Brenda:
25 Sep 2008 2:56:29pm
A C sec is not a lifestyle choice.
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Jez:
25 Sep 2008 3:13:27pm
Brenda - where do you make the leap from "personal choice" to "lifestyle choice"? Are you really suggesting that some women make the choice to have a C section the same way they select furniture, clothing or cars?
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stuart keynes:
25 Sep 2008 3:23:06pm
The choice should be based on the indivdual history of the mother and baby-to-be in the context of the latest research and knowledge.
It should be a frank and open discussion between the mother and her doctor, focused on the best outcome for mother and baby.
Sometimes it will not be clear cut, and the mother will have to make a choice.
If that's what you mean by 'personal choice', then fine.Agree (1) Alert moderator
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E.D.:
25 Sep 2008 2:11:55pm
Surveys don't yield accurate results when there are options to choose from that are perceived 'more socially acceptable' by the participant.
If I had to complete a survey and had the choice between 'concerned about the risk to the baby' and 'scared of pain' or even 'fear damage to my vagina' I think I know which one I would choose.
Maybe they should have asked how many women would have a baby if technology allowed it to be developed for the full term, outside the human body altogether...Agree (0) Alert moderator
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Di Wilton:
25 Sep 2008 2:12:59pm
Choosing a midwife as primary carer in pregnancy decreases the chances of a caesarean section. All research demonstrates that midwifery care is as safe as, and in many cases, more safe than care by an obstetrician.
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stuart keynes:
25 Sep 2008 3:26:44pm
Naturally mid-wives generate fewer patients for c-sections. They would be losing customers if they referred on!
My point is that there are many confounders to statements like yours, and research is very difficult in this area, as it is so subjective.Agree (0) Alert moderator
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Pen Pal:
25 Sep 2008 2:24:15pm
I just live in awe of the ladies who have to bear and give birth to our children.
If they want a Caesarean delivery, then go for it. I'm not a coward, but I'm not that much of a hero either.
When my daughter was born, I was at home tucked up in bed and received a 'phone call from the doctor telling me of the "happy and healthy" occasion.
I salute the Mums of this world!!Agree (0) Alert moderator
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Arthur:
25 Sep 2008 2:25:54pm
If women want a ceasarian then why shoud anyone stop them.
The most important thing is that it is an informed, carefully considered decision rather than passing judgement about the reasons for choosing one over the other.
No birth options are a walk in the park.Agree (0) Alert moderator
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Ssss:
25 Sep 2008 2:53:33pm
We should stop them for many reasons, not least of all the expense and huge drain on our health service it causes - both immediate and ongoing.
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Brenda:
25 Sep 2008 2:58:23pm
Whys hould anybody stop them? Because it's not a natural procedure and is not safer!
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Arthur:
25 Sep 2008 3:19:36pm
By-pass surgery is hardly natural, but I am not going to stop someone having one for that reason.
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mallory:
25 Sep 2008 3:05:38pm
Arthur, I totally agree with you. "An informed, carefully considered decision" is very important. But are women being properly informed? Many obs are recommending c-sections without warning of the risks and after-effects. In many cases they are selling them as the "safest" option, when in fact, the empirical evidence suggests that in many of these cases it is actually a riskier option. That is not allowing women to make "an informed, carefully considered decision" and that is the biggest problem.
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Arthur:
25 Sep 2008 3:24:07pm
Maybe a better survey might be what amount and level of information brought about their decision. That would be a bit more interesting than this loaded survey.
My wife has had both and with our third and last child she chose vaginal. I would say she was well informed by then.Agree (0) Alert moderator
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MereMale:
25 Sep 2008 2:32:44pm
I may be a bit naive but... what's wrong with being 'too posh to push'? If a mother told me she wanted a Caesarean just to avoid the pain of labour I'd think she was a wise woman.
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klaus:
25 Sep 2008 3:11:38pm
There are many risks involving a caesarean birth. The truth about caesarean birth is, you might get away with may be 10 hours of agonising pain, but you're really exchanging that for 2 days of being bed ridden and in quite some pain because your abdomen has been cut open and you need the wound to heal. Natural birth mommies goes home at day 5. whereas caesarean birth mommies have to stay for additional 2 days. That says quite a bit.
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Simon:
25 Sep 2008 3:24:57pm
Crap Klaus.
My wife recently had her third C/section. No two days of pain- more a mild discomfort and each time out in 5 days. In fact 4 days for last- she got tired of getting told 6 different ways to look after the bub by 6 different midwives.
All kids are happy and healthy.Agree (0) Alert moderator
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Emma:
25 Sep 2008 2:33:20pm
What this article ignores are the significant risks to mother and child of having a cesarean - which is major surgery. And the significant benefits of a vaginal birth.
The fact that these women thought it would be 'safer' to have the baby by cesarean section shows that a significant number have probably been duped by their expensive obstetrician (who is thinking foremost about his golf handicap, his skiing holiday in Switzerland and his insurance premium) into thinking that cesarean is safer than a vaginal birth when by all accounts, it is not.
As more and more 'obstetricians' become surgeons and lose the skills of helping women to give birth vaginally, more will push for their patients to have cesars, because they are unconfident and de-skilling in these areas. Only midwives seem to have continued to retain these vital skills of how to manage a live birth, rather than simply intervene surgically.Agree (0) Alert moderator
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Jez:
25 Sep 2008 3:18:37pm
Emma - why the passionate hatred and evil stereotyping of obstetricians?
For our first pregnancy we had an emergency caesar at 28 weeks, and I can assure that our obstetrician, she was a godsend, and not thinking about anything else other than the safety of mother and child. We then elected to have a caesar for the second child, rather than trial the scar.Agree (0) Alert moderator
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bob:
25 Sep 2008 2:39:16pm
I notice in the article that some 46% of elective surgery are because of concerns about the safety of the baby.
What has changed that so many babys are now in such grave danger through a natural birth that they must be cut out instead.
Or is it just an reason to have an 'elective' ceaser, as the term 'elective' means by choice and not 'at the gynos recommendation for the health and safety of mum, bub or both'.
I thought the female body was designed to do this birthing thing, but then again what would I know I'm just a 'male'.Agree (0) Alert moderator
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Jack:
25 Sep 2008 2:40:50pm
Sorry, but this study is flawed.
A simple socio-economic analysis of the postcodes where these women choosing CS live would reveal a marked economic factor.
But, that is not to say that CS should be denied to anyone who needs it.Agree (1) Alert moderator
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Sarah:
25 Sep 2008 2:43:20pm
My private Ob made it pretty obvious on the day of my labour that my failure to progress was inconveniencing him. He gave me no reassurance or positive encouragement to persist with a natural delivery, and couldn't be more pleased when he finally pursuaded me into a caesar, threatening me with risks of harm to the baby if I didn't take this option. Of course, none of this was necessary, he was just a bully. I am now pregnant again, and pursuing a natural delivery (vbac), which is now a rather hard thing to do as medical professionals don't want to accept the "risk" of a natural delivery post-casearean. Obs have a lot to answer for, they're the ones who are pursuading mothers to take this unnatural and often unnecessary surgical procedure, as opposed to a natural and empowering birth.
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Chris:
25 Sep 2008 3:09:16pm
Stick with it, my wife did a vbac and was so happy with the result.
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mumof2:
25 Sep 2008 2:56:57pm
I've had 2 emergency ceasers and favour the natural method as my resesarch has led me to the decision that natural births are better than ceasers, except in emergency situations.
A lot of the information you recieve from gp's and obstetricians about complications emphasises and dramatises the risk, rather than puts it in appropriate context. I think you need to look into the risk yourself to make an informed choice and try and get information from journals, midwifery sites and from both points of view.
I also chose midwife led care as they are less likely to have unnecessary interventions than gp's and obstetricians. Midwives are well trained to perform this service. In fact my midwife recognised very early that my labour was unusual and required medical assessment. My healthy baby was born by ceasarean but the placenta was found to be abnormal. I haven't suffered and hope our third baby is delivered naturally .Agree (0) Alert moderator
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Simon in Adelaide:
25 Sep 2008 3:02:26pm
What the article FAILS to mention is that statistically a Caeserean poses many more risks to both baby and mother than natural birth does ( and before I get howled down by the pro lobby..... of course there are exceptions to this ) ..... as a dad and passionate believer in natural childbirth, I say to all prospective parents.... DO YOUR RESEARCH, DONT JUST TAKE WHAT THE DOCTORS/HOSPITALS/OBSTETRICIANS SAY .... CONTACT A MIDWIFE.
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klaus:
25 Sep 2008 3:04:45pm
From our experience, it was the obstetricians who seems to be a bit more trigger happy with their scalpel especially those who are at a private hospital. We had to change 3 obstetricians because our son was in a bridged position until week 40. Had we not persisted on natural birth, he would have been born premature at week 37. I think it's the obstetricians' ethics that needs to be reviewed.
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Skeptical:
25 Sep 2008 3:05:12pm
Nothing will ignite debate more than the Caesar vs Natural debate - it also naturally collects the Doctor vs Midwife debate and the "care" that they both provide.
Can I alert the readers to a salient point - "Seventy-eight women were surveyed, all private patients. Three-quarters of them were first-time mothers and one in five had used IVF."
ie 1 in 5 had difficulty getting pregnant - it is understandable that they have heightened concerns regarding their unborn childs welfare. Please also note that history (across multiple cultures) has shown us that it is the first pregnancy/delivery that has the highest complication rate.
The result may mean that these women were making an informed choice - and exercising that choice. All being privately insured gave them a lot more power in the decision process than what they would get by not having private cover.
I think "too posh to push" is a very superficial interpretation of results.Agree (0) Alert moderator
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Bill Anderson:
25 Sep 2008 3:06:30pm
What did the study expect those surveyed to say? They did it for selfish reasons? It was a forgone conclusion that most woman would say that they did it for the baby's sake. What a waste of scientific resources. Why don't they do something that is backed up by actual evidence rather than the group heresay of a group of vunerable woman cringing under the spotlight.
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Cablehorn:
25 Sep 2008 3:14:25pm
Australia has an infant mortality rate of 4.4 deaths/1,000 live births. Sierra Leone has 160.3 deaths/1,000 live births.
Argument re caesars vs normal birth is a bit indulgent.
How about a bit of praise for our wealth, our doctors & nurses.Agree (0) Alert moderator
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mel:
25 Sep 2008 3:14:29pm
After a 22 hour labour then an emergency C section (def not my first choice) for my first and a 12 hour labour and natural for my second. i personally by far would choose natural over c section. My dr the second time round was really pushing me to have a c section (only because I had one the first time round), which I was really reluctent to do - the midwives gave me heaps of encouragement and information on having natural after c section and I am def glad I listened to them and not my dr. If I go for a third I will be going natural unless I had no choice and had to go c section.
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Andrew:
25 Sep 2008 3:15:45pm
"ignite debate"
...debate from where, and between who? Are there really people out there who are arrogant enough to believe that their way is the one way, the only way, to give birth?Agree (0) Alert moderator
