The Politics Of Natural Birth

Sydney Morning Herald

Tuesday October 21, 2003

Vagina is best that has been the mantra of childbirth for many years. It is natural, it is less interventionist, it allows the woman to maintain control, it reduces costs, it reduces complications. Women have fought for the vagina, health groups have battled for it, and governments have supported it. But now a heretical idea has arisen what if it is not so? What if a planned caesarean section is best?

The concept comes from smatterings of research which show that caesareans are getting safer, that cost differences may not be great, and that the complications of caesarean section (an abdominal wound plus all the small risks of surgery) may possibly be lower than the complications of a vaginal birth (lacerations, painful sex and later urinary incontinence). In a couple of situations where the baby is breech (lying feet down) and where the woman has HIV research has shown that babies benefit from their mothers having a planned caesarean section. But the question is now being asked: would this be true of the standard, head-down, full-term baby?

It is a question worth asking, simply because women and policymakers deserve to know everything possible about the impending birth. Which has the greater chance of delivering a healthy baby? Which produces fewer short- and long-term complications for all? Is there a difference in emotional impact? Is there a cost difference?

Such a study is being proposed in the United States, but some fear the consequences of a caesarean being shown to be safer. More caesareans means less control for women, more intervention, more antibiotics, a possible de-skilling of midwives and obstetricians (who may forget how to deal with difficult vaginal births that will still occur) and a further medicalisation of a natural process. But politics aside, if elective caesareans lead to greater chances of healthy babies and healthy women, then that should be known. Women could have the choice.

This is not an easy question to ask as it challenges so many assumptions. In the wider field of health care there are many similar questions. Do private hospitals provide better care than public ones, or just better meals? Do specialists guarantee better results than registrars, who are specialists in training? Does private insurance offer any advantages in health rather than financial or emotional terms? They all deserve an answer.