Real Reasons for Cesarean Sections?

Has the reproductive system of the 21^st century woman suddenly malfunctioned?  Has it suddenly ceased to innately give natural birth?

How else can we account for the alarming increase of induced and caesarean births?  The World Health Organization (WHO) recommendation for caesarean section rates fall between 5%-10% and yet WHO survey around the globe affirms C-section rates at ‘epidemic’ levels. 

• Nearly half of all births in China are delivered by cesarean section, the world’s highest rate — a shift toward modernization that isn’t necessarily a good thing.

• The WHO, which reviewed nearly 110,000 births across Asia in 2007-2008, found 27 percent were done under the knife. 

• In the U.S., C-sections are at an all-time high of 31 percent. A government panel warned against elective C-sections in 2006.

• In Latin America, C-section rates in all eight countries surveyed earlier by WHO were 30 percent or higher — similar to the U.S. rate.

These figures are very frightening for an expectant mom like me who wishes to give natural and gentle birth. Left and right, friends and loved ones end up birthing under the knife.  You hear the all too familiar reasons – fetal distress (which prompts one to wonder why babies too have forgotten how to be birthed), low amniotic fluid, going past due date, failure to progress, repeat cesarean births… reasons which are highly debatable in the first place.  Still, these don’t explain why such problems are so rampant nowadays.

These selection of books have given me so much confidence in natural birth.

I decided to dig deeper. I searched for books written by doctors themselves who validates the importance of natural birth from a medical point of view.  After having gathered sufficient knowledge straight from the horses’ mouth, I can, to a large extent, pin it down to two major factors:

TESTS, TECHNOLOGY AND INTERVENTIONS

Take the case of continuous use of external fetal monitoring (EFM), where two large straps are placed around the abdomen to detect baby’s heartbeat and uterine contractions, which has become standard practice. In The Birth Book by William Sears, M.D. and Martha Sears, R.N., it asserts that “the problem with EFM is that what the monitor says and what’s going on with the baby are not necessary correlated. Not everyone is equally skilled at interpreting nor is there uniform agreement as to what the different patterns mean. Also, recent research suggests that damage to a baby’s brain (e.g. which later causes cerebral palsy) occurs mainly before labor begins and is usually not due to insufficient oxygen during final passage. Indeed, when EFM was introduced to hospital procedures, cesarean section rates doubled, yet babies did not turn out any better”.

Another device that found its way into standard obstetrical practice is the regular ultrasound check-up.  Although it is very useful for pregnancy with complications, it has, however, become an unlikely tool for grounds of labor induction and cesarean births on an otherwise healthy pregnancy. Responsible for determining estimated delivery date (EDD) and amniotic fluid level (AFL), it has largely contributed to the rampant induction of labor for supposedly overdue babies and low amniotic levels despite not being backed up by studies and statistics to necessitate such procedure.  What about scheduled cesarean sections for breech babies when there is still time the baby will turn?

OBSTETRICS ‘FEAR OF MALPRACTICE’

Modern society’s notion is that the more we intervene, the better for the baby.  Doctors test, monitor, measure, and invade to try control every aspect of pregnancy and delivery.  Intervention then becomes an option if birth doesn’t go according to a predetermined timetable.

According to The Birth Book, fear of malpractice is a contributing factor to the cesarean epidemic.  If a doctor “did everything” including a section and the baby was still less perfect, the jury is less likely to find the doctor at fault.  In fact, obstetricians believe that number of surgical births will be cut into half if not for the legal consequences hanging over their heads. This succinctly explains the reputed phrase “the only cesarean I’ll be sued for is the one I don’t do”.

In the comprehensive and well researched book “Gentle Birth, Gentle Mothering” by Sarah J. Buckley, M.D., many commentators have recognized a link between high cesarean rates and having obstetricians as primary birth attendant:

“There is a higher level of comfort that obstetricians feel with the risks associated with cesarean deliveries compared with those associated with vaginal deliveries. In contrast, low-technology models of care (midwifery, birth center, homebirth) are at least safe, involve fewer interventions, and have lower cesarean rates – typically below 10 percent”.

The combination of the ubiquitous use of technology and fear of “not intervening enough” is a powerful force behind the alarming rise of surgical births. As Dr Sears points out, if technology cries wolf, the ultimate question is what to do with the findings -is it just an unusual pattern or the baby is really in trouble?  Not wanting to take chances, the hospital path from delivery room to operating room becomes a road frequently traveled.

Technology is perhaps the greatest paradox of our modern lives. It has given us so much, yet it has also stripped us some valuable wisdom from our modest past. In the name of ‘extra precaution’, this has given way to routine tests, invasive technology and unnecessary interventions.  Never mind that for centuries babies were birthed in the safety of their homes and mothers trusted her instincts.  She felt connected and well attuned to her own body and baby, a time when women felt most empowered.