The Beliefs of Canadian Maternity Care Providers - Who to choose when your choice is cesarean?

The Canadian Journal of Midwifery Research and Practice published a study entitled "Midwives' Belief in Normal Birth: The Canadian Survey of Maternity Care Providers' Attitudes Toward Labour and Birth", by McNiven, et al. in Volume 10, Number 2, Summer 2011. The paper examines the results of a survey conducted in 2007.

It should be noted that midwives generally believed that a vaginal birth was a more empowering experience than a cesarean birth, that those who deliver by cesarean miss an important life experience, did not believe that cesarean prevented urinary incontinence or sexual dysfunction, agreed that there should be an organized pre-cesarean section peer review of all cesarean sections to reduce the cesarean rate, and agreed that all cesareans should be subject to a peer review to reduce the cesarean rate. Further, midwives are most likely to believe that childbirth can be considered normal prospectively, that childbirth doesn't usually require medical intervention, to prefer natural methods of pain relief, and that home birth is as safe as or safer than hospital birth. Personally, I did not find my vaginal birth to be more empowering than my cesarean birth (quite the opposite), and in terms of life experiences, frankly, I wish I would have missed out on the "life experience" of vaginal birth. That being said, I always believed that having a midwife as a prenatal care provider would be a poor fit personally, and the results of this survey seem to confirm that belief.

However, midwives have a tendency to portray themselves as some kind of guardians of patient autonomy. So what did the midwives of this survey think about a woman's right to choose cesareans?

More than half (58.6 percent) did not believe a woman had a right to choose a cesarean in the absence of a medical indication. Slightly fewer than one in five (18.5 percent) believed in a woman's right to choose cesarean.

What was surprising is that the view regarding cesarean sections was largely consistent with the views held by both Registered Nurses and Family Physicians who provided prenatal care with 60.4 percent and 60.8 percent of those providers disagreeing with a woman's right to choose a cesarean even in the absence of medical indications.

With regards to the right to choose cesarean, obstetricians were the most likely to agree that a woman has a right to choose a cesarean with 42.3 percent agreeing a woman has a right to a cesarean and 15.3 percent taking a neutral position.

I find it somewhat disconcerting, that the right to choose a cesarean in Canada among those providing prenatal care is so widely disagreed with (but particularly among midwives, RN's and family physicians). It seems trite to me that a patient has the right to decide what is done with their body (among the available options, after considering the advice of care providers) - the fact that it is not trite in prenatal care in Canada is disturbing.

Hopefully the memo that was sent regarding patient autonomy more than 25 years ago in the Morgentaler case will soon be received by the majority of those providing prenatal care in Canada.