Sarah Buckley: Mothers not just too posh to push | Opinion | The Australian
The article above disputes the idea that it is women wanting unwarranted caesareans which is pushing up the rates of such deliveries in Australia. Her figures indicate that there are few mothers asking for it without good reason.
However, last week, two obstetricians discussed the issue on Radio National (audio available here), and I was surprised to hear both of them say that there are cases where, despite explaining all of the risks and disadvantages in detail, some patients will still insist on a caesarean birth, and they felt that they had no choice but to provide that service.
This seems very strange to me. Why should any obstetrician comply with a request to provide an unwarranted medical procedure which is known to have worse health outcomes for both the mother (who at least can give her consent) and also the baby (who obviously can't.)
Isn't there some risk that, if the baby suffers a complication typically arising from caesarean birth, the father could sue the doctor on behalf of the baby for providing an unwarranted and more dangerous procedure? I could see this as a scenario especially where the father and mother are estranged either before or after the birth. Or do the doctors also seek the father binding waiver before the procedure?
I know that lots of people have unnecessary cosmetic surgery despite its risks, but as I say, there is only the need to consider one person's interests in those cases.
In the multiverse version of Earth where I am benevolent and wise ruler of Australia, obstetricians are just ordered to refuse the request for unnecessary caesareans, and doctors doing cosmetic surgery are sent to work on remote aboriginal outposts. (Oh, hang on, I have closed most of them too.) The producers of Big Brother were fed to the crocodiles long ago.
5 comments:
There is a paradox in Australia that public obstetrics, despite carrying a higher risk case load, has a lower CS rate than the privates. I think what really happens is that if you have been seeing an obstetrician for 8 months and you are due and distraught to the point that you can't face another day of pregnancy you will be induced and since that often fails require a CS. It is no use telling the public doctor you have never seen before that you have be delivered now because you will be ignored.
The number of women demanding a CS up front is small. What they usually demand is to be delivered now! I've heard in Brazil CS rates approache 100% for private patients but I gather that is at the request of males.
As far as suing obstetricians I am still waiting for all the money awarded for cerebral palsy cases to be refunded now that has been found not to be due to burth trauma after all. The poor obstetricians are damned if they allow a labour to proceed with a poor outcome or go for CS and get a poor outcome. Either way, in retrospect, the other decision may have been better, but the doctor does not get the option to decide retrospectively.
An interesting post Steven, as always.
Geoff
Thanks, Geoff. Why do you think Brazil's private rate is due to males?
I agree with your point about suing obstetricians; they have been badly treated by the legal system. My question about whether they could be sued for a totally elective CS (for a rich Mum who just wants the birth by a certain date) remains valid, though.
Why would rich macho Brazilian men not want their wife's vagina to be stretched and lax from a vaginal birth? You really are too damn nice Steven.
Yes, you original point stands but ,as you suggest, is only likely if the couple is estranged. Since CS is an established medical procedures with a risk vs benefit discussion to be had, I don't think a woman could turn around and sue. Perhaps he could sue his estranged partner for the choice she made. Would be ghastly all round.
Geoff
Geoff
Yes it is true, I am not the kind of person to stand in a bar chatting with the mates about how stretched and unsatisfactory my partner's vagina has become!
Okay, okay, sorry guys but the vagina is intended to stretch, for birth, and the muscles - for thankfully they are muscles - bounce back, just as good as they ever were. Pelvic floor exercises help this process along.
Isn't the body a wonderful thing?
I hasten to add, I have heard and read of supposedly educated women having CS because it was medically "essential" - they were too dumb to understand that their vaginas / sex lives would not be ruined. What ignorance and what vanity.
Women don't demand CS so that they cam give birth on or by a particular date, that's plain silly.
I can well imagine some women being afraid to give birth naturally (well, most do it with an epidural, and I've never considered a needle in the spine, and therefore being paralysed and not being able to push particularly natural), and in those circumstances, I can equally imagine a doctor agreeing to the request for a CS. The last thing a doctor wants is an uncooperative and hysterical women unable to cope with labor and birthing.
I don't think anyone has ever studied this aspect, but I think more and more it may be a factor.
Ever given birth guys? It's not the worst thing, really it isn't, but women share around so many "horror" stories that it's a wonder that 100% of women here don't demand CS.
For the record: I planned a home birth, was in labor for 3 days, was finally put on a drip in hospital to progress things, gave birth without drugs late on the fourth day.
My daughter started natural labor, was unnecessarily put on induction drip (they thought labor was too slow, after only a few hours), continued in labor for numerous more hours, before emergency CS - fully baked, perfect, nine pound baby was very nearly lost, and spent his first couple of days in intensive care. All ended well, but not because of good medical management.
After all that, if my daughter ever has a second child, she intends to have a CS. I would fully support her decision.
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