Birth: the final frontier
There’s a very good reason why decisions about birth provoke strong reactions. They concern the youngest, most defenceless members of society. Babies have no say in anything that happens to them. They depend on us as their caregivers to make the right choices for their safety and future health.
I may not believe in the inviolable superiority of natural birth, but I certainly empathize with the sentiment. The major obstacle faced by proponents of natural birthing is practically the same as the one faced by proponents of breastfeeding (myself included). I may want to empower women to have confidence in their ability to breastfeed. But what about the woman who tells me she’s perfectly happy not breastfeeding, thank you - and I can stuff my empowerment?
The attitude of the mother herself is what I consider the “final frontier” in the struggle for higher rates of natural birth, and breastfeeding. The importance of tackling it is in inverse proportion to the degree to which it can be tackled. For no matter how passionately you feel about babies’ rights, you can’t commandeer another person’s body - whether it’s to get her to give birth naturally, breastfeed, or refuse an abortion.
The question is: is it ethically neutral for women to choose non-medically indicated cesareans?
The stated ethics of the natural birthers have to do with ensuring the baby’s (and to a lesser extent, the mother’s) safety and future health. But I would argue that the ethics that really drive them are more of the philosophical, ideological variety.
I should know: I feel the same way about breastfeeding. (I don’t doubt that “breast is best.” But where do figures like the breastfed baby’s additional “8 IQ points” come from? How many “facts” like this do I take at face value simply because they help confirm my beliefs about the superiority of breastfeeding?)
One “fact” that put me off choosing a cesarean for Naimah’s birth was the one about surgical births being associated with higher rates of childhood asthma (incidentally, so is a lack of breastfeeding).
I well remember my younger brother suffering with asthma throughout his early childhood. As it happens, he was born by cesarean. As it also happens, I wasn’t, and have never suffered from asthma.
Forming conclusions based on a sample size of two is never recommended. At the same time, it’s understandable for family memories, which involve the emotions, to play a significant role in the decisions we make.
So, what is the evidence for cesareans “causing asthma”? Sarena mentioned a “50 percent additional risk” - a figure I found referenced in the following study: http://cme.medscape.com/viewarticle/576897 (to access the article, Google the link). A 50 percent increase sounds bad. But what does this translate to in real terms?
The prevalence of asthma was 2.3% in women who delivered by cesarean delivery, 1.9% in those with instrumental vaginal delivery, and 1.4% in those with spontaneous vaginal delivery.
Rounding up and down, what this means is that for every 100 children born vaginally without instruments, you would expect 1 to get childhood asthma. For every 100 born by cesarean, you would expect 2 to get asthma. And for every 100 born by instrumental vaginal delivery, you would expect… well… about 2.
Wait a minute… I was born by instrumental vaginal delivery! That made my chance of developing childhood asthma almost exactly the same as my brother’s!
To be precise, the difference between my and my brother’s risk of developing childhood asthma, according to the study, was 0.4 percent. That equates to less than half an extra child out of every 100.
Of course, if you ignore the part about instrumental delivery (as the media did), it’s 0.9 percent, which you round up to 1 percent - which makes a 50 percent rise. Scary!
The natural birthers will also have us believe that mothers are themselves more likely to die if they choose a cesarean. Is this well founded?
Sarena linked us to an interesting article in the Telegraph, supporting her belief that cesareans are too dangerous to represent an ethical choice.
I don’t know whether Rebecca Smith, the newspaper’s medical editor, has any qualms about the U-turn her articles on birth have taken. But personally, I’d feel a little sheepish to be publishing Women choosing cesarean have low death rate less than 6 months after Death risk higher for women “too posh to push.”
Meanwhile, for the countless women calmly electing surgical birth every day, the fact remains that when a qualified obstetrician acquiesces readily to a cesarean, it is reasonable to assume that it is because it does not carry a significantly greater degree of “death risk” than the alternative.
According to Professor Philip Steer, British Journal of Obstetrics and Gynecology editor-in-chief, in his viewpoint C-sections “a rational choice”…
Delivery by Cesarean section… is remarkably safe - certainly as safe as many of the cosmetic operations that do not excite similar criticism.
He also writes…
You would think that [the] technological advances [affording safe surgical birth] would be greeted with universal acclaim, but many women see childbirth as an essential “rite of passage” and exhort others of their gender to eschew technological assistance (is this “the female macho”?).
While I agree with Professor Steer’s article as a whole, I feel it’s too easy for a man to dismiss the idea of natural birth as a rite of passage. It’s a bit like someone who can’t get into university dismissing the aspirations of undergraduates looking forward to receiving their diploma. For, the fact of the matter is…
If giving birth naturally matters to you (= is a rite of passage, a spiritual womanly act), then it matters.
If it does not matter to you, then it does not.
I can’t make a woman want to breastfeed, and Sarena can’t make a woman want to give birth naturally. But let’s remember to be critical of the “facts” about birth safety presented to us in the media - particularly when they contain riveting or catchy phrases such as “death risk” and “too posh to push.”
As the contradictory Telegraph articles, and the medical community’s support for both vaginal and surgical birth would suggest, neither vaginal nor cesarean birth is significantly more dangerous than the other. Both can be highly dangerous without the proper support. Both have become remarkably safe - in developed countries at least - thanks to skilled midwives and doctors attending births.
I mean, no one can ever guarantee that your vaginal birth will go as planned. And I stand by what I said before: It’s like rolling the dice and risking two 1’s as much as two 6’s. And in some ways, the near certainty (of course, a cesarean can always go horribly wrong) of two 4’s can be a wonderfully reassuring thing when you’re talking about your one and only body. Either way, you will have your lovely baby!
I’d been to It’s a Small World before - I’d remembered it was pretty alright. Nothing could prepare me for the teary-eyed experience of going with Nim. Outside, the giant clock face (an actual face!) with its surreally lagging tick-tock (”Tuh! Tuh!” said Nim). Inside, pretty little lights dotting silhouettes of the house we’d just entered (visible, top left of the picture). Had it always been this romantic??
