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Q: One of the most talked-about topics among modern mothers is Caesarean section. On the one hand midwives and many motherhood organisations seem to be quite against it. Some doctors, however, seem to be in favour of it it on an elective basis. What is your take on this debate and why is there such a strong divergence of opinion? How do you manage this question with pregnant patients?
A: I feel that every birth is individual. Every labour and birth experience is unique and different in each woman. I try to give the patient an informed choice and support her in her decision. I always attempt to encourage the patient to go as “naturally as possible”.
However, in many instances the patient has had a previous traumatic natural birth, or there are other fears that influence the decision making. The decision to embark on an elective Caesarean section is certainly not taken lightly and the patient is fully counselled.
The Caesarean procedure has become extremely simple compared to 20 years ago and there is prospective evidence that the mother and child are in no more danger than normal. Anaesthetics are safer and are done under a regional block. In a
Caesarean section, the abdominal muscles are not cut, but pulled apart and there is no cutting of any muscular tissue. Thus there should be no more distortion of the abdominal muscle walls than with a normal delivery. I think that much of the "anti" opinion is based on old statistics and dogma in the management of C-section.
Q: Why then do so many medically-trained mothers go for an elective C-section?
A: There are potential issues with a normal delivery that they may be concerned about, like pelvic floor damage - leading to potential incontinence and vaginal laxity. It is something most people don’t talk about, but medical people might believe in the “risks of the modern C-section”.
Q: There is much Internet literature quoting higher risks for C-section versus natural birth. What is your opinion?
A: A lot of these statistics may be manipulation by people with an agenda. For instance, the data quoted above is usually from early studies. Techniques have improved dramatically since then.
However, most importantly, if you want to compare apples with apples, it is impossible to take a sample of 10 000 normal pregnancies and 10 000 C-sections (containing mothers needing emergency operations, having predisposing medical problems, or being whisked away from failed labour) and say “Gee! Look, the mortality rate is higher in C-sections”. That’s a pretty unfair comparison. My feeling is that a sampling comparing low risk elective C-sections and natural births (which is an impossible study) would show no real differences in mortality or morbidity.
(Dr Martin Puzey, registered gynaecologist)
