Caesarean surgery: is it simply another way of being born?
Does a caesarean give babies the safest possible entree to the world, conveniently protecting the mother's pelvic floor at the same time?
Or is a caesarean a substantial deviation from normality that introduces potential risks for mother and baby? Could our current caesarean epidemic even be a reproductive time-bomb, increasing risks as caesarean mothers proceed through subsequent pregnancies and births?
A NSW government-funded committee last week declared that their caesarean rate- 28.1% in 2005 and climbing
- is too high, and unveiled plans to reverse this upward trend. In the public sector, women requesting a non-medical caesarean will be
counselled about the risks for herself and her baby, with the aim of reducing the
'too posh to push' component of the caesarean drive.
Whether this directive - also introduced in the UK National Health Service
- will reverse the upward trend is unknown. What is certain, however, is that the debate is hotting up.
A large US study published in September 2006 found, for the first time, that caesareans may be more harmful for the baby. Researchers found that low-risk babies born by caesarean to healthy mothers were almost three times more likely to die in the first year of life, compared to babies born vaginally.
A French study, published at the same time, confirmed the risks to caesarean mothers. Results showed that healthy women were more than three times more likely to die after a caesarean, compared with women giving birth vaginally. Major causes of death were haemorrhage, anaesthetic complications and blood clots
These risks are certainly acceptable when a mother or baby's life is in immediate danger. However caesarean risks don't end there. Life-threatening complications continue for mother and baby in every subsequent pregnancy. These include ectopic pregnancy; uterine rupture and life-threatening placental complications.
For example, women with a previous caesarean are more likely to have a
'morbidly adherent placenta' causing major haemorrhage after birth. In extreme circumstances, the only treatment is an emergency postpartum hysterectomy. This previously rare procedure is seven to eighteen times more likely after a previous caesarean, and is becoming more common in Australian maternity hospitals.
These problems aren't only impacting official statistics; they are also creeping into Hollywood. For example Madonna, whose first baby was born by emergency caesarean suffered a life-threatening placental abruption with her second child.
But aside from these obvious complications, what does it mean for mother and baby to experience a
'vaginal bypass' at birth?
Research is increasingly recognizing the complex and sophisticated system of normal birth, designed to prepare the baby for life outside the womb and the mother for her maternal career, including breastfeeding. This system has been refined through 175 million years of mammalian evolution and is aimed at ensuring long-term reproductive success, which is the basis of species survival.
Vaginal birth gives babies (of all mammalian species) a head-start in life, The stress of being born activates the lungs, in preparation for breathing; increases blood sugar in preparation for independent metabolism; and stimulates virtually all body systems for the radical change in environment that birth brings.
Elective caesarean babies, born without labour, miss this hormonal preparation. They are consequently two to three times more likely to have breathing difficulties after birth; five to six times more likely to need artificial ventilation for severe breathing problems; and three to five times more likely to need intensive care after birth for any reason.
Caesarean babies may also have significant handicaps in the longer term. For example, a caesarean baby misses the usual bowel colonisation at birth from the mother's
'friendly bacteria'. Caesarean babies have abnormal bowel flora until at least six months -- and probably life-long. This deviation from normal may impact their immune function, increasing the risk of allergies and asthma in later life.
For the mother, a caesarean is major abdominal surgery, with the unavoidable risks of haemorrhage, infection and blood clots.
But more than this, caesarean mothers also miss the elaborate hormonal orchestration that Mother Nature prescribes to enhance ease, safety and pleasure for mother and baby of all mammalian species.
For example, in the final stages of labour, the mother experiences an immense outpouring of oxytocin, the hormone of love, which physically aids her with birthing her baby. Oxytocin also activates the mammalian
'maternal circuit' in her brain, priming her for motherhood and creating feelings of calm and connection as she meets her baby for the first time.
When women miss these rewards and pleasures, it is not hard to guess that birth rates will drop. Research shows that women have fewer subsequent children after a caesarean birth.
There are signs that the glorification of surgical birth is waning. Perhaps we are listening to the cold, hard facts, or perhaps we are at last learning some respect for women's bodies, superbly designed over 175 million years for reproductive success.
Dr Sarah J Buckley is a GP, mother of four, and author of Gentle Birth, Gentle Mothering.
