Call the midwife!

Caesareans are now the most commonly performed surgical procedure in the United States. Hardly a statistic to encourage prospective or pregnant mums, and the rate of a surgical delivery in Australia is only a fraction below that of the US, where it has now reached 1 in 3 births. Yet World Health Organisation recommendations say the C-sec rate should never be amore than 10 -15 percent in any area or for any reason, so clearly something is very wrong.

The fear with which many women approach the unknown “pain” of labour is driven by media stories and by obstetricians, many of whom have private patients insured for all eventualities. The rate of surgical delivery among privately insured women is notoriously higher than for those in the public system, which says a lot about the spurious reasons for surgery! Only when obstetricians and hospitals are somehow rewarded for keeping surgical deliveries to within WHO guidelines, might we see a change. I have a friend who is a long-time practising obstetrician and visiting specialist at three maternity hospitals in NSW Australia. The intervention rates at this doctor’s hospitals are well within the WHO-recommended range, yet when he presents to his professional colleagues on how they might emulate his approach, his words are dismissed. His peers make it plain that lowering their C-sec rates is not on their agenda and that such rates should not be viewed as a competition.

Damn shame! But if the doctors have vested interests in continuing high surgical rates, what hope is there for the women in their care? Time to “call the midwife” if you ask me! All you need to know about avoiding a surgical delivery ...

Stand and deliver!

Hannah Dahlen, Professor of Midwifery in the School of Nursing and Midwifery at University of Western Sydney, raises a very valid question. Why are Australian women still lying down to give birth? I’ve been writing about the benefits of being upright during labour for almost thirty years - but I’m just one of a chorus of voices advocating an active birth and explaining the role of gravity in assisting the baby down the birth canal. I’m just one of hundreds describing the ways in which women laboured in traditional societies - sitting on a pile of bricks or on a birthing stool, hanging suspended with the help of ropes, or supported in a squatting position. Even in modern birthing suites, if women are not instructed by a midwife or obstetrician, they will almost all give birth upright and forward leaning ... wonderful how their bodies know instinctively which way to go.

Of course the trend to birthing in the horizontal position is linked to the medicalisation of birth and the move from midwifery to obstetric care - the doctor’s job is facilitated when the woman is horizontal and at eye level. Dahlen calls for women to get off the bed and “stand and deliver.” When you’re upright to give birth you can expect stronger contractions, shorter labour, less need for forceps, vacuum extractions and episiotomies and better health for you and your baby. So get off the bed girls!