Monday, December 25, 2006


By Bettina Arndt

The battle was supposed to be won more than 30 years ago when the women's movement pushed for the right to make informed decisions about their health care.... Women emerged determined to no longer be passive recipients of over-medicalised health care, particularly during childbirth. But those of us old enough to remember those days are blown away by what's happening in today's obstetric care.

Recently a 50-something Sydney midwife spent a few days working in a Sydney private hospital. She was amazed that of the 30 to 40 new mothers she cared for, only a handful had vaginal births and many chose elective caesarean with no medical indication. How can so many women have been hoodwinked into thinking that a caesarean is the best option for them and their babies?

What's happened is the doctors have been burnt. There have been some major payouts for medical negligence over cases where it was argued obstetricians should have done a caesarean, or done one sooner. The result is obstetricians are fast losing the skills to handle the difficult cases.

This all gives the impression that caesareans are a safer method of delivery, for women and their babies. Yet, a recent French study suggested caesarean delivery more than triples a woman's risk of dying in childbirth compared to vaginal delivery. Luckily these risks are small, but they rise significantly with each caesarean. These babies are more likely to suffer respiratory distress; labor prepares babies for breathing by massaging respiratory organs and aiding elimination of mucus from their systems.

Yes, there are horror stories but many women are being conned into thinking caesareans offer an easy way out. Even the broken coccyx I experienced during my son's natural birth was nothing compared to the ordeal of recovering from my two caesareans. For every mother on the internet claiming the caesarean was a breeze, there are others talking of horrible post-surgery pain, the problems looking after a new baby with a painful scar, difficulties with healing, long-term complications.

It's hardly surprising there is evidence caesarean births mean mothers are more likely to have early parenting difficulties and post-traumatic stress. Yet our caesarean rates are soaring. The caesarean rate hit close to 30 per cent in 2004, increasing to 38 per cent for women in private hospitals, according to figures released by the Australian Institute of Health and Welfare. If these figures keep rising, it may spell the end of normal vaginal births. There simply won't be the skilled obstetricians or midwives available to help if the going gets tough.

And more mothers and babies will die as a result. Countries like Brazil, which have already gone down that route, are showing increases in maternal and child mortality. In affluent areas of Brazil, there are hospitals with more than 80 per cent caesarean rates. Across Australia, maternity hospitals are already feeling the strain, as elective caesareans add to the burden on theatres, surgical and nursing resources.

Women contemplating elective caesarean, without good medical reasons, need to understand the risks to themselves and their babies. The majority of Australian women believe women's bodies were made to give birth without a knife.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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