Monday, November 12, 2012

Is CDMR a societal and professional failure?

In this month's edition of Lamaze's journal Birth - Dr. Michael C. Klein will publish an article entitled "Cesarean Section on Maternal Request: A Societal and Professional Failure and Symptom of a Much Larger Problem".

I wish that this article would focus on the professional and societal failure associated with maternal request cesarean and the much larger problem. However, knowing Dr. Klein as a staunch natural childbirth advocate who is ideological in his belief that medical intervention should play a minimal role in birth; I know that this article will disparage the choice that some women make to deliver by way of cesarean as being driven by misinformation and fear and will completely fail to address the much larger problem.

I would argue that the rates of maternal request cesarean are indeed driven by misinformation and fear. In short, I believe the risks and negative impacts of vaginal delivery are understated and the risks and negative impacts of an elective cesarean delivery are overstated. Further, I believe that the advantages of vaginal delivery are systematically inflated, while those of cesarean delivery are systematically discounted. I believe that the fear of surgery drives many women to avoid it - even when a surgical delivery would have resulted in a better outcome for either mother or child than a vaginal delivery. I also believe fear and misinformation drive a lot of women to forego epidural pain relief. Yes, fear and misinformation are a big problem when it comes to birth - and likely result in lower rates of maternal request cesarean and use of epidural pain relief than would be 'ideal' as many women who would have a much better birth experience by having an elective cesarean or using epidural pain relief forego doing so based on misinformation and fear.

I also believe that the situation around maternal request cesarean is a symptom of a much larger problem. That problem is that not all women are supported when it comes to the choices that they need to make during pregnancy, labour and delivery. That the information given to women regarding pregnancy, labour and delivery is heavily biased. That many women have difficulty finding a provider and a care facility that will be supportive and respectful of a mother's requests for cesarean delivery and in many cases even access to epidural pain relief. That many other women seem to think that it is okay to criticize the informed choices some women make to deliver by way of cesarean or use epidural pain relief.

I will also agree with Dr. Klein that the system of maternity care, particularly in British Columbia, is in dire need of reform - all pregnant women need to be supported and empowered to meet their own needs with unbiased information and access to medical care including access to surgical delivery and epidural anesthesia on request. All pregnant women need to know what their choices are, the risks and benefits of those choices and to have the right to informed consent. Further, all pregnant women need to know that their choices will be respected and confident that just because they are pregnant does not mean that they lose the right to decide what is done with their body.


  1. Mrs W. I just wanted to say thank you. Before you, I was unaware that one could request a csection. My husband and I had decided to limit our family size because I could not take the psychological trauma of a vaginal birth again. Even with the epidural, I was left feeling vulnerable and out of control of my own body. It was not something I was willing to repeat. On the other hand, I have had abdominal surgery. While there was pain the control of the events made them easily bearable. Thank you for showing me I can have more children without having to go through such suffering again.

    1. Best of luck to you and your family - may you have every happiness and the support and care you need as you look to expanding your family.

  2. Well said. Just noticed that your birth story thread on was closed by the moderators. The very fact that someone would choose a c-section seems to have blown the minds of a few members who. just. can't. accept. it.

    And then a whole bunch of zombies were dug up and let out to play (zombie = an idea that has been conclusively disproved but refuses to die).

    We are so far ideologically from patient-centered maternity care because of the pervasiveness of the natural/ vaginal is best bias. It's hurting women that don't share that value set.

    1. I absolutely agree - the natural/vaginal is universally best does need to be challenged and we need to move back to patient centred care.