Showing posts with label Maternal Request. Show all posts
Showing posts with label Maternal Request. Show all posts

Thursday, July 5, 2012

Maternal Choice Caesareans: Misunderstanding, Misinformation and Misogyny is Still Alive and Well in Canada

Recently, Jamie Komarnicki of the Calgary Herald wrote a news story about a doctor (Dr. Magnus Murphy) who is publicly advocating for women to be able to have the choice of caesarean. The story got a lot of play across the country and has been picked up by many other news papers, and has resulted in a number of radio interviews. Dr. Magnus Murphy, is a urogynecologist and a former obstetrician. He has seen first-hand the longer run effects that normal birth has on women and has spent a good part of his career surgically correcting those problems. That’s right, the big push to avoid surgery (c-sections) – often results in surgery months or years later for many women. Recently, Dr. Murphy teamed up with journalist and well-known caesarean advocate Pauline Hull and published what is the most comprehensive and compelling book on the subject to date, Choosing Caesarean, and despite its title, neither Dr. Murphy, nor Pauline Hull is about selling caesareans to everyone or out-rightly abandoning the way children have come into the world since the start of humanity. Rather, they see it as a reasonable treatment option that should be considered relative to the default of vaginal delivery – one that will be appropriate for some and inappropriate for others. They see it as a matter of informed consent and choice – and they also see women being denied an opportunity to make a choice that might be of clear benefit to themselves as individuals. They present clear evidence of the often generally unknown facts of these two delivery options.

It’s good that this information is getting out there and that the universal supremacy of normal birth is being questioned – it’s about time women were made more generally aware of the choice they are making, the risks and the benefits of both vaginal and caesarean delivery options. It’s about time the information given to women about birth didn’t just come from the Natural Childbirth Industry.

What’s sad is that the comments sections in response to the stories are invariably filled with misogynistic, misinformed and misguided sentiments about this subject. People seem more than willing to make other peoples’ bodies, their business. I will happily concede that everyone is entitled to an opinion on a subject, however, the opinions expressed on this subject are generally far from well-informed and many demonstrate a tremendous lack of logic or understanding of the issue. Everyone is an armchair OBGYN. Of the 14 comments made on the story when I looked, 9 were negative – ranging from benign misunderstanding to utterly misogynistic. Here is a small selection of some of the less enlightened comments on this particular news story that I’ve read – I’ve copied them verbatim, so any spelling or grammar errors are not my own:

Golden Years:

“I don’t think they should be elective – but whatever, that’s your choice I guess. If you do “elect” to have on though, you can darn well pay for it on your own. Not on my dime!!!”

Steve Q:

“Quack quack.”

Anon147951286:

“Personally, my opinion. .. A vaginal birth is "natural" our bodies were designed to give birth. C sections are not natural, in some circumstances women need the help of a c section due to complications of child birth. I do not think its right to have a doctor pushing his ideas on women telling us childbirth vaginally is not safe- women have given birth forever . I have given birth 2x and I and my children are healthy and fine. Firstly- pregnancy ruins your bladder, and if your bladder is not drained before pushing a child out that can also ruin it. Get the facts people. I'm not against a c section- but it is also a major surgery. If its because complications with a natural birth- fine. If not, why would we do otherwise?”

Anon916080527:

“I personally would not want a section unless it was an emergency. Women that have a normal vaginal deliver are out of the hospital in a day or two. The women with sections are dragging their IV poles around the recovery is much longer.”

Notnecessarily:

“I’m sure there’s a financial benefit...the health benefit...not sure that is a guarantee for either baby or mother.”

Schapdel:

“Women have been having babies for thousands and thousands of years before modern medicine and we’re over 6 billions on the planet. I think the natural way works fine thank you very much!”

Bill200:

“And tell me again about those ballooning health care costs? What the heck- let’s take what’s normally a low-risk, relatively short and natural procedure involving no surgical intervention, and turn it into a major surgical procedure that requires women stay in hospital for multiple days.

Are their complications from natural childbirth? Yes. The advocates for c-sections suggest the complications from emergency c-sections should not be compared to natural childbirths. Equally, the complications of planned c-sections should be compared to natural childbirth, rather than simply talking about the latter.

Anyone who advocates for this is probably either going to make money off it by performing c-sections, or wants her own choices to be viewed as “natural”. C-section doesn’t form the basis for a “natural birth plan”, notwithstanding their book title.”

Dostros:

“Breaking News....Big pharma company promotes taking expensive pills for whatever ails ya’!”

Toyota:

“If you can’t do the time, don’t do the crime. Honestly, women and their partners today need to get a grip on reality. If you want a c-section for reasons other than an emergency, you should look into a surrogate.”

So what should women who are more informed on this subject do?

They should support those who are brave enough to put themselves out there and advocate for fully informed choice about birth options. They should work to dispel some of the myths and misconceptions that are commonly held by also commenting on these stories. They should call out the stupidity, misogyny, and failure in logic for what it is. They should think critically about what is said, and question whether or not it is actually coming from somebody who knows what they are talking about. Lastly, they should talk with their own health care providers, they should review the legitimate evidence on the subject, and they should proudly make whatever decisions best serve their own needs and those of their children – and respect the decisions of others, even though they may be different from the ones they would make for themselves.

Respect is not just given, it is earned. So go out and earn it!

Friday, January 6, 2012

On Being Canadian and Wanting a Maternal Request C-section


Despite being cultural cousins, there are significant differences between Canadians and Americans. We have gun control. They have a constitutional right to bear arms. We have universal health care. They don't yet have unversal health care. We have highly trained and regulated midwives. They have the "Certified Professional Midwife"...which is a very different critter (see The Skeptical OB for more on this).

One significant difference that I failed to appreciate while I was awaiting Juno - is the significant difference between the Society of Obstetricians and Gynecologists of Canada(SOGC) and the American Congress of Obstetricians and Gynecologists (ACOG).

The Society of Obstetricians and Gynecologists of Canada (SOGC) has produced a Joint Policy Statement on Normal Childbirth - in December of 2008. In it there are some serious contradictions, on one hand "6. All pregnant and birthing women and their families should be able to make informed choices. All candidates for normal birth should be encourage to pursue it." and on the other hand "4. Caesarean section should be reserved for pregnancies in which there is a threat to the health of the mother and/or baby." and "5. A Caesarean section should not be offered to a pregnant woman when there is no obstetrical indication.". Also of interest is In short, the SOGC is supportive of informed choice, so long as that choice is "Normal Birth" wherever and whenever possible. It is clear that the SOGC is well aligned with the practice of midwifery in Canada.

Compare this with the American Congress of Obstetricians and Gynecologists who put out their stance on maternal request c-section in December 2007 and reaffirmed it in 2010. The ACOG recommends that "1. Cesarean delivery on maternal request should not be performed before gestational age of 39 weeks has been accurately determined unless there is documentation of lung maturity. 2. Cesarean delivery on maternal request should not be motivated by the unavailability of effective pain management. & 3. Cesarean delivery on maternal request is not recommended for women desiring several children, given that the risks of placenta previa, placenta accreta and gravid hysterectomy increase with each cesarean delivery." Overall, the ACOG is reasonably supportive of maternal request c-sections, provided some very reasonable conditions are met. I might argue that the unavailability of effective pain management (ie. lack of epidural access) might be considered a legitimate reason to request an elective c-section, given that unmanaged pain during labour likely predisposes a woman to post-natal PTSD.

I should note that I had heard of Canadian women successfully planning c-sections, IN CANADA, without medical indication before - I therefore thought that surely if one was clear in her request, consistent in her wishes, that this was something I too could secure. All I needed to do was ask to be referred to a doctor who was open to maternal request c-section and ask to be referred to an OB who would agree (after providing information on the relative risks and benefits) to perform the procedure. I did that, it didn't happen.

So if I were in those shoes again - a Canadian nullipara, informed on the risks and benefits of elective c-section vs. vaginal birth and intent on planning an elective c-section; knowing what I know now about the stark difference in stance between the ACOG and the SOGC; I would have bit the financial bullet and would have given birth in the USA. It is also pretty clear to me right now, that if I want #2 to be born via elective cesarean at term, I might stand a much better chance of achieving that goal south of the border.

Alternatively, if I were an American worried about the intervention happy ACOG, perhaps I would go North - in pusuit of 'normal birth'.