I personally know 6 OBs who have had homebirths with their own babies -- knowing that the hospital, and especially the OR, is NOT the place to bring babies (or mothers) optimally and safely through birth.
In the end, it really is true that you are much more likely to get surgery when you hire a surgeon! What else should we expect? How many people out there don't realize that obstetrics is a SURGICAL practice?! It is NOT the practice of normal, natural pregnancy or childbirth - or even women's or baby's health for that matter. It is the specialized skill of surgery -- cutting the abdomen, uterus, and surrounding organs to extract a baby. It is a great and useful practice when it is truly NEEDED. But this rarely is the case when it comes to normal, physiological birth.
The ignorance surrounding this subject is infuriating.
Nearly half of obstetricians in Canada say a woman should have the right to choose a caesarean section when there is no medical reason to warrant one.
The finding comes from a nationwide survey of maternity care providers that found many obstetricians appear to support the wide use of technology, despite a push by their own professional body to "normalize" childbirth and reduce Canada's rising C-section rate.
Forty years ago in Canada, five per cent of babies were delivered by caesarean. Today the rate is 28 per cent nationally, and more than 30 per cent in B.C. and P.E.I. More than 78,000 C-sections were performed in Canada last year.
The Society of Obstetricians and Gynaecologists of Canada says a C-section should not be offered to a pregnant woman unless there is a valid medical reason to perform one.
But the University of B.C.-led study found that 42 per cent of obstetricians were in favour of a woman's right to choose a C-section for herself, even in the absence of a medical indication.
Overall, 549 obstetricians, 897 family physicians, 545 nurses, 400 midwives and 192 doulas from across Canada were surveyed in 2008-2009 on their attitudes toward labour and birth. The study was done against a background of a "technological transformation of birth," the researchers say — rising C-section rates, more induced labours and routine use of epidural analgesia, or local anesthetic.
Among the key findings:
- Most obstetricians agreed that epidural analgesia interferes with the normal progress of labour. Epidurals can slow labour, sometimes so much that labour stops. But 60 per cent of obstetricians agreed that epidurals ought to be routinely offered to women. Midwives and doulas disagreed mostly strongly with the routine use of epidurals.
- The majority of obstetricians are against routine fetal monitoring. "And that's a good thing," says Dr. Michael Klein, emeritus professor of family practice and pediatrics at UBC and the lead author of the study. "But that is not what's happening on the ground."
A recently released Canadian survey of more than 6,000 women who gave birth in the last few years found 91 per cent experienced electronic fetal monitoring during labour; 63 per cent said they had continuous electronic monitoring.
Routine electronic fetal monitoring increases the risk of a C-section, because it can lead to so-called false positives, "meaning it tells you there's a problem, but it turns out there isn't," Klein says.
"People have been hearing that message for 20 years or more, and so they know what the answer to the question is. But, in reality, imagine that you're a physician in your office and you have a woman who is in labour. Where should you be? You should be with her in labour. Where are you? You're in your office.
"The electronic fetal monitor is kind of your surrogate presence. It gives you a sense of security that you're somehow in control of the situation, when you're really not."
- 42 per cent of obstetricians were in favour of a woman's right to choose a C-section without medical indication, but only 21 per cent of obstetricians agreed with the statement that a C-section is as safe as a vaginal birth for women, and only eight per cent would choose C-section over vaginal delivery for themselves or their partners.
Klein said the findings reflect a dissonance between "what they feel about this (C-sections) and how they would respond to a request." Only 18 per cent of obstetricians said a C-section is safer than a vaginal birth for babies; 58 per cent disagreed with the statement.
"Women's autonomy is a value that we all share," Klein said. "But we believe that it has to be informed autonomy. And the obstetricians are kind of caught in the middle of this one. 42 per cent of them would support a woman's choice, but the problem is they're also the ones doing the cesarean section, and they're also the ones who have to have very long discussions with people about the benefits and risks of cesarean section. It takes a couple of hours by the time you're through, and nobody has that kind of time."
"It's in many respects easier to go along with the woman's choice — especially if you actually believe cesarean section is not a problem."
Studies show risks to babies from C-sections range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Risks to women include higher risks of hemorrhage requiring a hysterectomy, blood infections, wound infections and blood clots in the lungs. As well, every C-section increases the risk for another.
Klein said family doctors who provide only prenatal care, and then transfer women to an obstetrician for delivery, have attitudes and beliefs close to those of obstetricians.
- Only 35 per cent of obstetricians were in favour of birth plans and they were ambivalent towards doulas.
- 25 per cent of obstetricians and family doctors believed sexual problems and urinary incontinence could be prevented by C-sections.
- 43 per cent of obstetricians disagreed with the statement, "For a woman, having a vaginal birth is a more empowering experience than delivery by cesarean section."
"You really have to be fair to the obstetricians," Klein says. "What they believe is based on their training, and it's based on their experience, and they are much more likely than midwives to see problems, because they're in the business of problem-solving, while the midwives are in the business of normalizing birth and keeping birth normal. There's an intrinsic difference in style of practice and approach which goes with the territory."
But the survey also found that more than 15 per cent of obstetricians have attitudes on most issues "that fall squarely into midwifery territory," Klein says.
The study is published in the Journal of Obstetrics and Gynaecology Canada.
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