Childbirth: It’s time to stop the fear-mongering!

My initial reaction to Claire Harvey’s article; Childbirth: Why are we going back to the medical Middle Ages? (The Daily Telegraph, July 31st 2016) was one of anger and frustration. Here we go again, I thought. Yet ANOTHER article designed to scare the bejesus out of pregnant women. As if women are not frightened enough about giving birth? Her opening line says it all; “If you don’t fear childbirth, you must be crazy. It’s the most dangerous time of a healthy woman’s life. It’s the moment at which she’s most likely to lose her child.”

Really? Let’s look at the ACTUAL statistics shall we?

Less than 1% of Australian babies are stillborn (a figure that has not changed significantly in many years) making Australia one of the safest places in the world to be born (Source: Australia’s Mothers & Babies 2013).

Maternal morbidity rates in Australia are also amongst the lowest in the world – approximately 0.007% (or 7.1 deaths per 100,000) (Source: Maternal deaths in Australia 2008–2012).

I am not sure what the maternal and neonatal death rates were in the Middle Ages, because as far as I am aware, they weren’t keeping those sort of records between the 5th and 15th centuries. However, in 1900, childbirth was to be legitimately feared. Almost half of all women would not survive birth. Whoa! Hold up there for a second.

The previous sentence was deliberately struck through. Soon after publishing this blog, I received a lovely note from Natalie Mead at the Hunter Birth Education Centre. Many of us have heard the statistic “almost half of all women would not survive birth” and yet, when you think for a few minutes what that actually means – that would be preposterous. That’s called an epidemic, but more importantly, it’s an urban myth. So thank you very much Natalie, I stand corrected! Please have a read of her article where she has referenced some excellent historical sources which very firmly debunk this statistic.

Let’s look a bit more carefully at the primary causes of maternal death at the turn of the 20th Century; puerperal pyrexia (infection), haemorrhage, convulsions (pre-eclampsia) and illegal abortion.

The major factors that contributed to significantly reducing the maternal death rate were;

  • The discovery of and subsequent widespread use of antibiotics (thank you, Dr Fleming)
  • The availability of blood transfusions
  • Sterilizing of obstetric equipment
  • Basic hygiene (handwashing, use of gloves, surgical masks etc.)
  • Smaller families (particularly since the advent of the contraceptive pill)
  • Better obstetric and midwifery practice

Let’s take a look at the Australian maternity landscape today for a minute.

We currently have an induction rate of 26%, a Caesarean rate of 33% (although this figure is significantly higher in our private hospitals) and a 12% instrumental delivery (forceps or vacuum) rate. As the rates of intervention have rapidly increased, the rates of maternal and neonatal morbidity are NOT significantly decreasing. To prove this, let’s look at the year I was born – 1972. The Caesarean rate in 1972 was approximately 6%. The maternal morbidity rate in 1972 was 0.0127 (12.7 deaths per 100,000). So in 44 years, we have seen an almost 500% increase in Caesarean rates, and five fewer women per 100,000 are dying. How can we possibly justify this?

As for Claire’s wild claims that Australian women are being denied pain relief in labour by anti-feminist, sadistic midwives and doctors – again, the statistics tell a very different story. 77% of Australian women had pharmacological pain relief in labour. The most common types were nitrous oxide (inhaled) (54%), followed by regional analgesic (33%) and systemic opioids (20%). I am going to go out on a limb here and make a guess that the 13% of women who did NOT use pharmacological forms of pain relief DIDN’T WANT IT.

Claire Harvey and I agree about one thing though. Birth trauma is real. Postnatal depression and perinatal anxiety is real and more women than ever before are suffering. But please don’t point the finger at advocates for normal birth. We know that a difficult birth, especially one that left a woman disempowered, is a major risk factor for perinatal anxiety and depression.

Including the tragedies at the Bankstown-Lidcombe hospital in her article was irresponsible and unethical journalism at its finest. They had nothing whatsoever to do with her premise that the “natural birth movement” is to blame. It was the result of a horrendous error on the part of the hospital’s maintenance department. Any midwife or doctor will be able to tell you that it is actually impossible to connect an oxygen tube to a nitrous oxide gas outlet – and vice-versa. And you can’t smell the difference in the gases either.

Claire Harvey’s obstetric and midwifery credentials include ; a) giving birth twice b) attending the births of two of her friends (“and they were both absolutely horrendous.”) and c) watching copious amounts of One Born Every Minute. Phew! I am glad we got that sorted out. Good to know that she’s well-equipped to comment on the work of the NSW Department of Health.

The over-medicalisation of birth is a fact. And it’s a fact that no one disputes. Not the World Health Organisation, not our government, not our leading obstetric and midwifery authorities, and not our women. Birth IS a normal physiological event for the vast majority of women and babies. Most women and most babies will be safe and healthy. Iatrogenesis – the inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon is what is largely behind the complications we see so commonly today. Through our obsession with artificially kick-starting labour, speeding up labour or by-passing labour altogether and opting for surgical birth, we are putting more women and babies at higher risk of complications – not lower.

It’s abundantly clear that Claire Harvey has a near-pathological fear of childbirth. And there is a name for this condition. It’s called tokophobia. My advice to her would be to seek out professional support for this, because good help is out there. What she should not be doing is writing articles in a national newspaper that countless vulnerable women will read. Her article was not journalism. It was cheap self-therapy and pure sensationalism.

Finally, I agree with Claire on one final point. It is a giant con. It’s completely anti-feminist. And it’s time women stood up to it. Women of earth – it’s time to take back your births.

Tanya Strusberg is the founder of birthwell birthright. She is a Melbourne-based Lamaze Certified Childbirth Educator and a Fellow of the Association of Certified Childbirth Educators (FACCE). She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), Empowering Birth Magazine, Rockstar Birth Magazine, Mum’s Lounge, Go Ask Mum and Whole Woman.