The Birth Wars – no end in sight.

Sadly, it seems we are no closer to ending the divisive birth wars any time soon. If anything, the chasm today seems almost impassable. Emotions run so high in this deeply personal topic where both ends of the spectrum believe so wholly in their conviction that their side is completely correct, that there is little to no room for an alternative viewpoint – let alone those annoying little things called FACTS. Extremist perspectives have historically never been all that productive, and we don’t have to delve back in the annals of time to work that one out.

Recently, a story appeared in the media which I think perfectly illustrates the point I am trying to make. Angela Mollard’s article in The Daily Telegraph; I’m sick of being told I was ‘too posh to push’, once again presents a completely one-sided perspective that dumbs down a deeply complex topic to its lowest common denominator. In just the second paragraph, Mollard betrays her bias when she explains that she doesn’t like to tell people that she had an elective Caesarean because she feared being targeted by “Birth Nazis”.

She goes on to say; “I’m hesitant to use a personal story to make a universal point but with 33 per cent of the 300,000 babies born in Australia in 2014 delivered via Caesarean, we apparent push deniers are far from a niche group. And yet we’re treated as heinous cheats, arrogantly bypassing nature’s most ancient practices while not giving a damn if our babies emerge mutated, intellectually compromised and failures of life’s first test, namely pushing their cauliflower-proportioned heads through a gap the size of a plughole.”

I’d like to deconstruct this a bit if I may.

We know from a lot of very good research that most women do not choose to have a Caesarean, unless there is a sound medical reason to do so. This is not a judgement on those who do opt to have one (out of choice), it is simply a statistical fact. It makes sense that most people would not opt to have major abdominal surgery unless it was absolutely necessary. Saying that, there are many instances whereby a woman has no medical need for a Caesarean, but from a mental health perspective, may opt for one, making it the best choice for her.

Out of the 34% per cent of Caesareans performed on Australian women (yes, we’ve gone up a per cent), only about 2% are performed due to maternal request. That leaves 98% who didn’t choose one. Whether they were really medically necessary is an entirely different matter and I might leave that for another blog. But you get my point. No one – I repeat no one – is blaming women for being “too posh to push”. They certainly are not being lambasted for being “heinous cheats” or “arrogantly bypassing nature’s most ancient practices”.

What mother doesn’t care about the health and well being of her unborn baby? What mother does not value her own health and well being? Mollard’s crude description of vaginal birth; “pushing their cauliflower-proportioned heads through a gap the size of a plughole” is clearly intended to polarise and divide. If not, and she really believes that this is a true depiction of birth, then clearly she needs some basic education on the physiology of birth.

Yes, the rising Caesarean rate is alarming – on this point, everyone is in agreement. Mollard’s mocking only goes to show her profound ignorance on the matter.  Everyone from the World Health Organisation to NICE (the National Institute for Health and Care Excellence) to the world’s leading obstetric body, FIGO (International Federation of Gynecology and Obstetrics) agrees that too many Caesareans are being performed. Are these the “Birth Nazis” to whom she refers?

  • WHO states that an elective Caesarean with no medical indication increases the risk of short-term adverse outcomes for mothers
  • There is an increased incidence of stillbirths in women who have a scarred uterus from a previous Caesarean
  • Babies born via Caesarean are more likely to be admitted to a neonatal unit with breathing difficulties
  • The primary reason for undertaking a Caesarean is a previous Caesarean – 80% of women have a repeat, resulting in an ongoing increase in rates, not to mention the increased risk of serious complications such as placenta accreta, placenta percreta, life-threatening haemorrhaging, the need for hysterectomy and future fertility issues

According to Mollard, “the fact is the growing Caesarean rate is due, in part, to the rising age of women giving birth, obesity and the increased size of newborns.” Actually; I call bullshit on this Angela. If you want to really understand the root causes behind the escalating Caesarean rate, I suggest you watch this video by esteemed Professor Gene Declercq, PhD from the Boston University School of Public Health.

These are the most common reasons cited (particularly from the obstetric end of the spectrum)

  • Mothers are getting older
  • More multiples being born
  • Maternal obesity increasing
  • Babies are getting bigger
  • Mothers are generally less healthy
  • Mothers are asking for it

Note what all these have in common – it’s not the system’s fault it’s mothers’ fault.

Well, here are the real facts:

  • Mothers are getting older – NO
  • More multiples being born – NO
  • Babies are getting bigger – NO!!
  • Maternal health is worse: obesity, diabetes & hypertension – Some
  • Mothers are asking for it – NO

Another fact: Three-quarters of all Caesareans are being performed for just three reasons; labour dystocia (also known as “failure to progress”, although many people would say that the problem is more likely to be “failure to wait”. Fetal distress (again – this is controversial given the widely acknowledged inaccuracy of fetal heart monitoring) and finally, malpresentation (basically, baby is in an awkward position, such as being posterior, or a potentially more problematic position such as breech or transverse. When a baby is just is a less-than-optimal position during labour, women can often change their position, or movement to encourage the baby to move into a more favourable position. However, many women find themselves lying flat on their backs, being monitored continuously and when the discomfort becomes too great, they often opt for an epidural.

This combination causes all three of these issues to come into play; a labour that slows or stalls, a baby who is more likely to go into distress – either because mum’s own oxygen levels are being compromised because she is lying on her back, compressing the Vena Cava, a major artery, or because of medications in the epidural or the Syntocinon drip that has been added in order to speed labour up and which is widely known to cause fetal distress. And finally, malpresentation – when mum is immobile, horizontal and her uterus is no longer contracting optimally, is it any wonder that her baby will cease to move down through the pelvis in an optimal position to be born?

Finally, Mollard’s claim that the ‘fetishization’ of natural childbirth has driven a wedge between women when they need each other most is just out and out crap. The real irony (which almost certainly has been lost on her) is that it is articles like hers that are in fact creating the wedge and driving it even deeper. Articles like this might be great for click bait, but they contribute nothing to the national discourse and creating an environment for respectful discussion and informed decision-making between women and their care providers.

Tanya Strusberg is the founder of birthwell birthright and the co-founder of Lamaze AustraliaShe is a Melbourne-based Lamaze Certified Childbirth Educator, doula and a Fellow of the Association of Certified Childbirth Educators (FACCE). Tanya is also a member of the Lamaze International Board of Directors, the first non-North American to ever serve on the board in Lamaze’s 60-plus year history. She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), International Doula, Empowering Birth Magazine and Rockstar Birth Magazine. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators. Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.