The great birthing con is taking choice away from women
Australia’s caesarean rate is too high, but the Government is too scared to take on the doctors’ lobby and legislate for midwife care.
AUSTRALIA’S caesarean rate of more than 30 per cent is disgraceful. The World Health Organisation recommends a caesarean rate of under 15 per cent, and the First World countries closest to that are the Netherlands (13.6 per cent) and Finland (16.1 per cent) – countries that have legislated one-on-one midwife care and have a medical culture that supports it.
The world’s best and safest care for low-risk pregnancies is one-on-one midwife care. This care has been recommended by countless investigations and studies because it drastically cuts rates of unnecessary caesareans and other negative outcomes. Since New Zealand made sweeping legislation on birth choices 13 years ago, the percentage of women there who choose midwifery care has risen from 14 per cent to 80 per cent. There are sound medical reasons for caesareans, but not 30 per cent worth. Some women and babies are being ripped off.
How can the “too posh to push” consider that they are making an informed choice when the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Chris Tippett, is on record saying, “the risks of caesarean for the mother are significantly greater, particularly if she has more than one caesarean. And secondly, it is very doubtful that there is any protective effect for the baby and there may be a significant disadvantage to the babies.”
Answer? Negative optimism. Which is basically “it won’t happen to me”.
Last year a US study of more than 5 million births found that babies born by medically unnecessary caesarean were three times as likely to die in the newborn period as those born vaginally.
Professor James King , chairman of a ministerial advisory council on infant health, recommends strict guidelines on caesareans for private and public hospitals: “Caesareans divert funds from normal childbirth, but if you are operating in a private, for-profit system there is no disincentive to put a ceiling on that.”
Dr Andrew Child, head of obstetrics at Royal Prince Alfred Hospital, has found that obstetricians in private practice fear legal action if they refuse a caesarean and the woman then has a problem birth. “They say, ‘if someone asks, we just go along with it’.”
Many women are sucked in by the idea of a specialist because they want to be special. You hear a lot of, “My obstetrician said that if I hadn’t had a caesarean I would have died.” Of course they are going to say that. Show me an obstetrician who has performed a caesarean and then said, “I’m sorry, you actually could have delivered vaginally.”
For many women, having a caesarean birth is like going to France and not seeing the Eiffel Tower. They suffer guilt, loss, anger, grief and depression because of feelings that they were bullied, coerced and manipulated at their most vulnerable. Many feel conned and cheated by “defensive medicine”, which is generally the route taken so that if legal action arises they can say, “At least I did something.”
I spent a day recently calling six hospitals asking for statistics on their birthing practices. I was greeted with, “Who did you say you were? And where are you calling from? And why do you want these statistics?” To which I replied, “To be informed.” I was then told, “They’re confidential and we generally don’t give them out to the public.”
Women generally make their decisions based on information from their peers. The majority will simply choose the same care that the majority of their family and friends choose.
So why won’t the Federal Government legislate for safer births with better outcomes for mothers, babies and society on the whole? Birth practices that would save the taxpayers millions of dollars?
Tony Abbott is too gutless to take on the doctors, because the doctors don’t want their profits or power eroded. The mere suggestion that the Government might take away their honey pot and power stick would have the AMA inciting panic and scare-mongering. It would alienate voters because the public will always believe doctors over politicians.
It is difficult to dismantle the deeply entrenched cultural status that doctors have of being gods. They can’t all be that smart, a fair whack of them vote Liberal. If they are so informed and so infallible why do some doctors drink-drive, smoke cigarettes, have obesity problems or take recreational drugs? Negative optimism fuelled by a deep sense of superiority.
The Cochrane Collaboration, an international not-for-profit independent organisation dedicated to providing information about the effects of health care, offers this conclusion in its Guide to Effective Care in Pregnancy and Childbirth: “It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by an obstetric specialist even if the required personnel are available.”
I rest my case.
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