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March 12, 2007Letter to the Editor: Push or pull By Jane Martin, The Sunday-Mail, March 11, 2007.
Given recent research into the risks of medically unnecessary caesareans showing an increase in risks to both mother and baby I find it astounding that a specialist obstetrician would describe caesareans as being the choice of informed women (1,2).
It is also concerning that caesareans are portrayed as “predictable” and part and parcel of a “streamlined, fast, efficient birth system.”
Ask hospital staff who work the conveyor belt of caesarean surgery and they will likely tell you that their hospital is under immense pressure, that they can’t cope with the numbers of caesareans in terms of resources or funding and that neonatal special and intensive care nurseries are full to the brim. This issue was touched on in the recent “Australia’s Mothers and Babies” report by the Australian Institute of Health and Welfare (3).
The rising caesarean rate does not equate to safer birth or better birth for mothers and babies when you take these factors into consideration. A recent study by the WHO showed that rising caesarean rates do not translate to safer birth care or better outcomes and can in fact result in more incidents of harm (4).
We need to get away from this concept that birth is a competition but we also need to acknowledge that when women have a poor experience of birth it can have a ripple effect on their lives (5), especially when they miss out on all the benefits that come with a well supported and positive labour and birth however it unfolds. A woman who makes the best decisions for her and her baby should be able to wear a badge of honour no matter how her baby’s birth unfolds.
Whilst this article attempted to look at caesareans from various angles and whilst Michele Hamer identified some common beliefs about birth, it wasn’t clear that many of these beliefs are misconceptions. To make the best decisions women need accurate information so they can make their decisions based on evidence and not based on fear.
Caesarean Awareness Network Australia was established in September last year to help redress the lack of good information in the public domain regarding caesarean surgery and vaginal birth after caesarean and provide an avenue for support to women who are exploring their birth choices or who are healing from a negative birth experience.
If the caesarean rate rises as Dr Ellwood predicts and the maternity care system is not drastically overhauled, it is clear to me that we have our work cut out for us.
Cas McCullough
National Spokesperson
Caesarean Awareness Network Australia
www.canaustralia.net1. MacDorman, MF, Declercq, E, Menacker, F, & Malloy, MH. (2006). Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with ‘‘No Indicated Risk,’’ United States, 1998–2001 Birth Cohorts. BIRTH 33:3 September 2006.
2. Shiliang Liu, Robert M. Liston, K.S. Joseph, Maureen Heaman, Reg Sauve, Michael S. Kramer. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176(4):455-60.
3. Laws PJ, Grayson N, Sullivan EA. Australia’s mothers and babies 2004. Perinatal statistics series no 18 2006 AIHW cat. no. PER 34:[Available from: http://www.npsu.unsw.edu.au/ps18.pdf.
4. Villar, J., Valladares, E., Wojdyla, D., Zavaleta, N., Carroli, G., Velazco, A., Shah, A., Campodónico, L., Bataglia, V., Faundes, A., Langer, A., Narváez, A., Donner, A., Romero, M., a Reynoso, S., Simônia de Pádua, K., Giordano, D., Kublickas, and M., Acosta, A for the WHO 2005 global survey on maternal and perinatal health research group. (2006). Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet, 367: 1819–29.
5. Beck CT. Birth trauma: In the eye of the beholder. Nurs Res. 2004 January-February;53(1):28-35.
December 19, 2006
Australia’s Caesarean Rate goes up 10% in 10 years: CANA responds.
New figures released by the Australian Institute of Health and Welfare have shown a 10% increase in the national caesarean rate in 10 years. Australia’s caesarean rate is now 29.4% overall and almost 40% in the private system.
“In 1995 Australia’s caesarean rate was just over 20 percent. That it has risen to nearly 30 percent in less than 10 years is alarming, especially in light of the fact that it hasn’t been accompanied by an increase in safety and improved outcomes,” said National spokesperson Cas McCullough.
“Considering that 1 in 3 women find childbirth traumatic and that this trauma is linked to obstetric interventions, this trend is concerning.”[1]
“Research shows only a small percentage of women actually desire an elective caesarean for no medical reason[2]. The World Health Organisation recommends a caesarean rate of 10 percent for medical reasons. This suggests a large majority of Australian women are not wanting or needing caesareans.
“The reason for the sharp increase in caesareans is down to the hospital system not meeting the needs of women and their families in birth.
“There’s a lot of unwarranted fear surrounding birth which is exacerbated by a lack of good information in the antenatal period and inadequate support for women to birth naturally. Plus I think there’s a lack of understanding about the longer term impact caesareans can have on women and their families.
“Research shows that women labour best when cared for by a known care provider (usually a midwife), who stays with them throughout the childbirth experience for emotional and physical support. The fact that private hospitals have very high caesarean rates is perhaps indicative of the fact that they do not offer this kind of care.”
CANA would like to encourage women and health professionals to source accurate information about caesarean surgery. Sources of evidence-based information including journals and respected organisations are available on the CANA website: www.canaustralia.net.
The full Australia’s Mothers and Babies 2004 report can be accessed at: www.npsu.unsw.edu.au/ps18.pdf
(Laws PJ, Grayson N, Sullivan EA. Australia’s mothers and babies 2004. Perinatal statistics series no 18 2006 AIHW cat. no. PER 34)
[1]Creedy, D, Shochet, I.M., & Horsfall, J. (2000). Birthing and the development of trauma symptoms: Incidence and contributing factors. Birth, 27 (2). pp: 104 – 106.
[2] A recent study done by the Childbirth Connection in the US (2006) found that less than 1 percent of women requested an elective caesarean for no medical reason. www.childbirthconnection.org. This mirrors similar results from an Australian study by Gamble, J. & Creedy, D. (2001) Women's preference for cesarean section: Incidence and associated factors. Birth 28 (2) 101-110.
September 11, 2006
Announcing the Birth of Caesarean Awareness Network Australia
100 women, partners and health care professionals attended the launch of a new national consumer advocacy organisation yesterday (September 10th)) in Brisbane. The Caesarean Awareness Network Australia aims to provide a voice for the nearly 1 in 3 women affected by caesarean surgery. The launch was held on the eve of National Caesarean Awareness Day (today).
National Spokesperson for CANA Caroline McCullough said:
“Through CANA women wanting more information on caesareans and birth after caesarean will be able to access local support networks, evidence-based information from health professionals, researchers and mothers who have had caesareans.
“Our website will include information on topics such as how to have an empowered caesarean birth, how to enhance early bonding between mother and baby in a caesarean birth, birth options after caesarean, understanding the maternal health system, how to optimise the chances of an uncomplicated vaginal birth, healing from negative birth experiences and what is having a caesarean really like?
“We’ll also have information on research and resources to help women find evidence-based information. There’s a lot of misinformation out there and many women are not even aware that caesareans carry risks. Caesareans can be life-saving operations but recent research shows the risks of a baby dying in a non-medically indicated elective caesarean are nearly three times that of a vaginal birth.
“Whether a woman has a caesarean or a vaginal delivery, she deserves to be given full and accurate information to inform her decisions and enhance her experience of birth for the wellbeing of herself and her family.”
“CANA will also lobby State and Federal Governments in conjunction with the Maternity Coalition to improve birthing environments and services for women having their babies surgically delivered as well as women seeking support for vaginal birth after caesarean (VBAC).
“One of the first items on our agenda is to address research practices related to women giving birth. At present birth is researched in much the same way as a new drug and this is unacceptable.
“The NHMRC needs more specific policies in place to guide clinical research involving pregnant women and their unborn babies. This is evidenced by the international outrage at the random allocation of healthy women to surgical birth in the Birth After Caesarean research trial which is currently underway in several Australian hospitals.
“This trial is currently being investigated by the NHMRC because of consumer groups raising significant concerns over the ethics and validity of this research. However, consumers should have been adequately consulted with in the first place.
“CANA will be asking hospitals and health policy makers to formulate policies based on primary research evidence as well as taking into account the social, cultural, psychological and physical needs of women. This can only be done by involving consumers in policy formation.
CANA can be found online at www.canaustralia.net or via email: info@canaustralia.net.
ENDS
References:
MacDorman, MF, Declercq, E, Menacker, F, & Malloy, MH. (2006). Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with ‘‘No Indicated Risk,’’ United States, 1998–2001 Birth Cohorts. BIRTH 33:3 September 2006.
Got a CS or VBAC story to tell?
CANA is compiling a list of women around the country who are happy to be interviewed by the media about their caesarean or VBAC experiences. You don't need media experience. You just need to be a mum and not camera shy. Email your contact details to info@canaustralia.net if you are interested.
Research Analysis
Sometimes, what we read in the papers about new research doesn't match what the researchers themselves say. Why is this? Statistics are open to interpretation. An example is an increased risk from .5% to 1%. Put like that it seems pretty low but how about if it was stated as twice the risk or double the risk? How research is interpreted depends largely on who is providing comment. Readers should be aware that most of the life-threatening risks associated with caesareans and vaginal birth (whether after caesarean or not) are extremely rare. Every woman needs to evaluate the risks of any operation (or conversely not operating) and put these into the context of her needs and her family's needs.
CANA is a participating organisation under the umbrella of the Maternity Coalition Inc. Website copyright (c) CANA 2006. Updated January 2008.