From the 1880’s onwards the operation was carried out more and more, even though the maternal mortality rate remained very high. Almost 80% of all caesareans ended in death for both the mother and child. From the 1900’s however the mortality rate had dropped dramatically to between 6-10%.
Evidently the caesarean section has a very long history but it is only in the last 100 years or so that and with the advent of modern medicines and the increasing progress of the health service it has developed into a relatively safe operation for thousands of women. Although today the mortality rate has been greatly reduced it is still double that of a vaginal delivery.
Dangers of the Caesarean Section
The dangers of a caesarean section well out number the risks of having a vaginal birth. Not only is the mother at risk, but there is also the safety of the baby to be considered.
There are various types of caesarean section, but the two most common are the emergency caesarean section, and the elective, or planned caesarean section. A planned or elective caesarean is either, when the obstetrician decides that the women would benefit from having a caesarean section because:
- Problems occurred during a previous birth or births and an elective caesarean would be safer than a vaginal delivery.
Or because the mother has decided that she would prefer a planned delivery because:
- She would like to plan ahead for the delivery so she knows when she can get back to work.
- She has a fear of giving birth naturally because of the pain.
- She has been misinformed about the whole concept of giving birth and pain.
- The mother insists on having a caesarean section because of an overwhelming fear of giving birth naturally due to being raped.
- She wants to maintain the teenage tone of the vagina.
Depending on which type of c-section the mother has or needs has a bearing on the dangers that could arise, although a majority of the risks involved are to do with the surgical procedure itself.
Having a planned or elective caesarean would entail being given an epidural (an anaesthetic to numb the lower half of the body which is inserted into the spine) to take away any pain felt during the operation, from the rib cage down. As with any anaesthetic it carries risks, and this one is no exception.
The most commonly feared complication of anaesthesia is death, although it only occurs in the region of 1 out of every 10,000 people who have this type of pain relief. Less traumatic are the more common problems after an anaesthetic like headaches, which usually respond well to pain relief, and low blood pressure, although this doesn’t appear to cause any major problems. Bleeding and infection at around the site of the needle are also quite common.
Other maternal risks include haemorrhage, infection around the wound site and pulmonary embolism. All of which could prove fatal to the mother. A majority of these conditions can lead to long-term problems, including adhesions, intestinal obstructions, an increased chance of ectopic pregnancy, bladder injury, uterine rupture, and hysterectomy due to haemorrhage. Many of these problems are not thought of when considering subsequent pregnancies and may cause the mother to become infertile.
Below are two stories of women whose friends suffered from complications following a caesarean section:
Lesley’s story
A friend of mine had a caesarean section for alleged intra-uterine growth retardation. She didn't want one and was deeply distressed by the whole experience. She developed an infection, which never really went away, and she died, five months later, from septicaemia.
It was about ten years ago that it happened, but even now I feel some of the fury at the waste and the fact that there was nothing I could do, and she lost her uterus that day when they operated because they couldn't stop the bleeding or fix the infection and she never woke up to say goodbye to her babies who were only 2 and 5 months or her husband who just couldn't comprehend why she'd only had a bit of a pain............
Angela’s Story
A friend had her last child by c/s 4 years ago. She is still in and out of hospital with scar infections. She is seriously overweight, which apparently exacerbates the problem, as it's hard for air to get to the wound inside skin folds. But then, maybe that's a reason for obstetricians to try extra hard to avoid c/s in large women, rather than using the woman's size as an excuse...
My mother's last c/s was in February 1997. She is slim. She still has problems with the scar - feels she has a pouch of fluid on her tummy after nasty infections earlier on, and has had bladder weakness ever since the op. None of this will be documented in her medical records as, like so many other women, she just puts up with it and wants to stay as far away from hospitals as possible.
Angela H.
Of course, if the women had planned to give birth naturally and her circumstances change so much that the surgeon decides she will need a caesarean section, it cannot be avoided. If the woman has a planned caesarean section then this benefits the surgeon and he pretty much knows it will be scheduled it into his day in daylight hours and will take little more than 20 minutes for him to do his job. But some surgeons insist on the mother being given a caesarean section because it fits in with his plans and he will be able to have a round of golf before his next patient.
It would appear that women, who choose to have a planned caesarean for no other reason other than convenience, are putting their own lives, and the lives of their babies at unnecessary risk. Women in Britain and around the world are now opting and even demanding that they have a caesarean section for no other reason than that of convenience. A caesarean section even when not an emergency, carries risks and can in some cases prove fatal. The child could suffer life-threatening conditions, which may lead to death.
After all being pregnant and having babies is not a condition or a disease, it is an inevitable and natural process of life.
In an elective caesarean section where the baby is not in danger, the risks to the baby of doing a caesarean section are still present, meaning the woman who chooses caesarean section is putting her baby in unnecessary danger. That fact that some women are choosing caesarean section strongly suggests most women are not being told the facts by either their obstetricians or midwife.
THE ROLE OF THE MIDWIFE AND OBSTETRICIAN
The role of the midwife is to inform the mother of what is best for her and her growing baby. Every woman who attends a doctor’s surgery is assigned her own midwife. Her job is to check and listen for the baby’s heartbeat, check samples of the mother’s urine, carry out essential blood tests, and keep a check on the mother’s weight. She will usually stay with her for the duration of her pregnancy and it is the midwifes duty to inform the mother what her options are and to guide her through the pregnancy the best she can without being judgemental or critical. Occasionally the midwife will attend the birth if it is either without complications or if the mother has opted for a home birth.
The obstetrician’s role is to see the mother at regular intervals throughout the pregnancy and to do more thorough check than the midwife can do. He/she will perform the scans at different stages of the pregnancy to monitor the baby’s heartbeat and check for any congenital abnormalities. He will measure the baby and from this he can estimate roughly how old the foetus is and give a rough guess as to when it will be born. He will also discuss with the mother, what type of birth she would like, or, he thinks she should have, based upon what he can see, her previous births (if this is not her first) and how the baby is progressing. His view should be unbiased, but if this is the woman’s first pregnancy she won’t know what to expect and so will by and large put all her trust into this man who has been practising for a number of years.
Below are the opinions of 2 midwives I posed a question to, on a web site named ‘Radical Midwives’ to enable me to gain some feed back from experienced midwives on what they think the reason is for women opting for elective caesareans. Below the question are the replies I received:
QUESTION
What are the views of midwives about high profile stars like Victoria Beckham who has had caesareans because of convenience? I am a student doing a project on this subject and would appreciate some feed back from professionals. Also what are the views of the surgeons who carry out these operations? Should mothers be given the choice and what are the risks to the mother and baby?
ANSWER 1
Regarding elective caesareans I am constantly told by local midwives
etc that the rise in inductions and caesareans is due to maternal
demand - it all pivots round whether the choice / demand is based on
informed choice - so many women I meet have agreed to elective c/s and
induction of labour without having being given the full picture
(saying that the ones that don't have the full picture often seem so
much more content in their birth outcome and 'blissfully ignorant?')
Yes, this is what our Trust claim, too. This was my response, in a recent
letter I wrote to the Chair:
"I was very disappointed to read your reiteration of the Trust's
justification of the worrying rise in the caesarean section rate as due to
an increase in requests and an increase in referrals for neonatal aftercare.
While this may be true, the World Health Organisations recommendation, that
any rate above 10-15% would include unnecessary caesareans, applies to
tertiary referral centres as well, and with appropriate incentive other
units are able to achieve these targets.
In response to the phenomenon of women requesting caesareans. Women are
also requesting one-to-one midwifery care during labour, increased
continuity of caregiver, and the option to give birth in an environment
which views birth as a normal physiological event until a problem arises.
Each of these has been demonstrated to decrease the caesarean rate,
especially the rate of primary 'emergency' sections, which is our greatest
concern. The issue of which of these requests are being prioritised is
politically vexed, as is the increased incidence of women's request for a
surgical delivery. Research indicates that most women who ask for an
elective caesarean section do so because they believe it is safest for their
baby. Though evidence may in the majority of cases indicate that labour
(and vaginal delivery if possible) is actually healthiest for both the woman
and her baby, these beliefs persist in a medical environment where pregnancy
and labour are viewed as pathological or normal only in retrospect.
One woman who had given birth vaginally twice before a malpresentation
resulted in a very long labour and her first caesarean section, said to me
recently, "Well, they told me I only had a 60-70% chance of a normal birth
and left it up to me. It's easier to arrange childcare if I just have
another section." The fact that women are offered such minimal
encouragement that they choose another section to facilitate childcare, and
that their request is met while women who desperately want appropriate
support and confidence to achieve a normal birth cannot always access it, is
simply unacceptable."
Yes, I question too whether such choices are fully informed.
Best wishes,
Shawn
ANSWER 2
My gut reaction is that the women who "choose" section do not fully
understand the potential risks of this major abdominal operation.
(Possibly because the potential risks have not been explained
thoroughly.)
I fully support women's choice when the choice is informed.
And I don't know about the "convenience" of caesareans - how convenient
is it when a woman then develops urinary infection, deep vein
thrombosis, chest infection, diminished mobility, wound infection,
urinary retention, etc, etc, etc.
How convenient would it be if the baby were to lose his/her mother?
Brenda F
Midwife
PERSONAL EXPERIENCE:
I have a personal interest in this subject as I myself have had three children, two of which were caesareans.
There is nothing quite like giving birth whether it is via natural birth or one kind of caesarean or another. Every woman’s experience is unique and special to her and yet similar to that of another. If a woman gives birth to two or more babies, each individual birth would be completely different in many ways, no two births are the same.
People sometimes ask why a woman would want to give birth a second or subsequent time, if it’s as painful as she makes out, but I’m sure there’s one thing most woman would agree on, and that is that after you’ve given birth and held the most precious thing you will ever hold, all the pain that she’s been through for the last few hours or even days, is forgotten in the blink of an eye. Maybe this is because if she could remember the pain of childbirth she would never give birth again. It is the hardest pain to bear but the easiest to forget.
Unlike the high profile stars mentioned above I like other women didn’t have a choice in how I gave birth. I failed to progress in labour and with my first child now aged 13 and my last child aged 4, I ended up having 2 emergency caesareans.
Although my consultant did offer me an elective caesarean for my third child, based on my two previous experiences (the second birth having been just twenty minutes or so from having another caesarean) I decided I to opt for a natural birth. The fear of an operation over took the fear I may have experienced in natural childbirth.
I thought the same thing couldn’t happen three times. Unfortunately it did. The baby got into fetal distress and her heartbeat dropped dangerously low. I ended up having another emergency CS. I put my husband though hell unnecessarily as he didn’t know whether he was going to see me, or his baby alive again.
Although the end result was worth all the pain and worry, the psychological effects of this birth on my husband were quite drastic. As a result, he decided he didn’t want any more children (this one being his only child).
Had I known then what I know now about the dangers of caesarean births, before I had them, I think the psychological effects of having major abdominal surgery, would have been far reaching and would have been channelled through to my baby, having a profound effect on the bonding process that comes soon after the birth.
CONCLUSION
The question that should really be answered is: Do women really have the right to request a caesarean section over vaginal birth just because that’s what they want, without any medical indication or justification?
A woman has the right to refuse medical attention even when she has been advised that she may need it. Can she be forced to have a vaginal birth as that is essentially what she is being told if she is refused the operation?
Doctors appear to be offering women caesarean sections due to fear of being sued if things go wrong in a vaginal birth. With a caesarean section, although the risks are higher and it is a relatively quick procedure, the woman has to first give her consent by signing an agreement with the hospital or trust. By signing this agreement she is saying that if for any reason things should go wrong, she new of the risks and the hospital cannot be held 100% accountable.
Pregnancy after all is not an illness, disease nor a medical condition. For most women, being pregnant and giving birth should be a natural process in which no medical intervention should occur. Only a midwife should be present to assist the mother and give her informed choices for which the mother should be responsible.
The woman is not forced to have a vaginal birth except by her pregnant state. A condition in which her self and or, her partner agreed when she decided to become pregnant, for which she must take responsibility for and not blame the medical profession when she can’t have what she wants.
A doctor cannot be blamed when a woman chooses to have a caesarean section and is refused. He is not obliged to perform an operation he feels is unnecessary just because that she wants one and with no justified reason. His first obligation is to the health of his patient. If he believes that the risks of performing a caesarean section out way the risks of a vaginal birth he has every right to refuse.
The costs to the national health must be considered. Any mother wishing to have a caesarean because of convenience is taking away valuable resources from women who need these operations for real medical or emergency reasons. To perform a caesarean, it takes
- 1 Consultant.
- Sometimes a doctor to assist the consultant.
- An anaesthetist.
- Surgical nurses.
- At least 3 midwives.
- Equipment.
- An operating theatre.
- A blood ready for transfusion if necessary.
- A longer post-operative stay in hospital.
- Painkillers for after the op.
This is all a huge drain on National Health Service resources, which, if unnecessary, has a consequence on the whole community.
With a normal birth this could consist of
- Maybe 2 midwives.
- An anaesthetist (if required to perform an epidural).
- Equipment.
In certain countries like Brazil, some hospitals have caesareans rates of 100%. Doctors are very low paid and so juggle their work between 3 hospitals but are paid per birth. This means they can deliver more babies by caesarean than they can by vaginal birth because of the time scale. A caesarean can take as little as 25 minutes whereas a normal delivery can take around 12 hours or more. It is hardly viable for a doctor to hang around and wait for the woman to give birth when he could take just a short time to perform the operation and be off to his next job.
Some Brazilian doctors try to justify their reasoning by saying that caesarean sections are safer than vaginal deliveries. They say they are less violent to the mother as a vaginal birth could cause haemorrhoids, bladder problems and problems with infection from episiotomies. Compared to a caesarean, the risks of major abdominal surgery far out weigh that of vaginal births 16 fold. These claims are unjustified. Really all they come down to is how much money they can earn and they do not consider the health and safety of the mother and child. Over 550,000 caesareans were performed in Brazil last year unnecessarily. This is of huge cost to the health service and cost millions in extra drugs and hospital resources. Also one midwife from the royal college of midwives points out that 90% of women suffer from some kind of morbidity after having a caesarean.
It would appear that what should be a happy, joyful, family event is turning into a terrifying medical operation. Only 30 years ago the caesarean rate was about 3%. Today however the rate is more than 20% and has doubled in the last 10 years.
The world health organisation recommends that the caesarean section rate should be no higher than between 10 – 15% as a maximum for developed countries. In some midwifery units around the UK, this can be as high as 40%.
Caesareans cost the National Health Service over £26 million a year and take away vital resources needed for other women and patients.
In private health care, hospitals receive considerable benefits from caesarean sections, as it is one of their most common medical procedures. It provides a majority of the hospitals income. They compete for the customer’s choice and discourage home births.
Again it looks as though all it comes down to is money.
Could it be considered as a form of cosmetic surgery, like breast enhancement. Although the risks for this type of surgery and very low compared to a caesarean.
In trying to conduct interviews, I couldn’t find any mothers, family or friends that had had or knew of anyone who had an elective caesarean apart from one. A friend of mine used to work for a wealthy family whose mother was a Lady. She said although Catherine was very pleasant, at the same time she was very body conscious and vein, very thin and neurotic about keeping her body in shape. When speaking in a telephone conversation, Catherine told Denise that she was expecting her second child and was nearing the end of the pregnancy. She described the pregnancy as nothing more than a pain, an inconvenience and a time wasting experience. She also told Denise that she had opted for an elective caesarean. Denise asked why, expecting a medical reason for having such a risky procedure, to which she replied, “Because I can’t be bothered to go through all the pain and it would save me time and as I can afford to pay for one and have it done privately, why wouldn’t I.
I think then that I can conclude that there are little more than 1 or 2 reasons, , why women choose to have a caesarean section. That is that either they can afford to pay for one or that they want to keep their body and their sex organs in tone and shape, or that they just haven’t got the time in their busy schedules to give birth naturally.
We are fast becoming a money-orientated country, who is obsessed with time and getting things done in the least time possible. Maybe the high profile stars like the attention and this is why they chose this mode of delivery. Or maybe they like the attention they receive from the press and the public when we are told that Victoria has had major abdominal surgery. Perhaps if things were to go wrong and something terrible should happen to her or her baby, she would enjoy that kind of attention too?
