Patient: I’m in phenomenal pain, my body feels like it’s tearing in two, could you teach me some breathing techniques to manage the pain?
Doctor: Does your religion ask you not to use medicine?
Patient: No, I’d just like to keep it natural. I’ve heard hot baths are good, or hypnotherapy.
Doctor: You do know it’s 2017? We have many forms of advanced medicine that ease your pain much more effectively than breathing, hot water or hypnotherapy and are perfectly safe to use with no lasting after effects.
Patient: I’d just like to keep it natural. I don’t mind if it hurts more. Nature designed me to take this pain.
Optician: I’m afraid you need glasses.
Patient: But my eyes were designed to see! How can I need glasses?
Optician: It’s perfectly common. Many people wear glasses. They will improve your vision and quality of life.
Patient: So did nature not want me to see?
Optician: Nature is unbiased and had no intention for you either way. Your eyes are evolved to see but they’re not perfect. Nothing in nature is perfect.
Patient: I can’t believe it. I feel as though I’ve failed as a human being.
Both of these scenarios seem pretty unlikely. Both might leave you questioning what’s psychologically wrong with the patient, why are they instantly rejecting modern inventions that can improve their lives? There are a million such scenarios I could write that you wouldn’t believe, but there’s one that seems perfectly rational, that is the commonly held view, and that’s childbirth. When it comes to childbirth, it seems there’s a totally different normal to every other medical scenario in life, and if you don’t agree, you’re the abnormal one.
I’ve long preferred a c-section over vaginal childbirth but heard on the grapevine that they’re incredibly expensive privately, and nigh on impossible to get on the NHS without a medical need.
In all the birthing plans I’ve been given, not one mentions an elective c-section. Wherever I’ve read about sections it’s assumed they’re a last case, unwanted scenario to be avoided at all costs and most likely regretted.
At some point in my first trimester, I came across the relatively hidden news online that as of 2011, all women who would like a c-section are entitled to one on the NHS. Even a gynae doctor I spoke to didn’t know this. No mid-wife has ever asked me if I’ve considered one as a birthing option. It was an unspoken secret.
The immediate response from people is ‘Yes, but they’re so expensive and risky, why should the underfunded NHS foot your bill if you don’t need one?’
And there’s the second unspoken secret, NICE, the body that advises the NHS, says that sections have very similar risks and very similar costs to vaginal birth. And when 1 in 6 vaginal births ends with an emergency c-section, you could safely assume they’re guaranteed to be cheaper than this scenario, as they skip the long labour, and they skip the emergency based costs given they’re planned in ahead of time, and they reduce the risk, as you avoid the hours of painful and unsuccessful labour which have left either mother and / or baby in distress and at risk of dying.
Maybe that leads in to the third unspoken secret, if c-sections have very similar risks to vaginal births, where is the list of vaginal birth risks? No-one has sat me down to go through them, though I had to sit down and prove I know the risks of a section before being granted one. Even the
Royal College of Obstetricians and Gynaecologists (RCOG)
advice on elective sections lists the pros of a vaginal birth versus the cons of a section. I’ve emailed them twice for the list of cons of a vaginal birth and pros of a section but I’m yet to get those lists.
If we go back to the nature point at the start of this post, it is true that our bodies are evolved to give birth, but nature, in its imperfect way, hasn’t evolved us perfectly. Nature doesn’t need or want all of a species to survive, only enough to keep the species going. Human rights don’t exist in nature. None of us has a natural right to life. Nature can take us out, in a storm, a wind, a wave, through disease, or childbirth, and that’s that. There’s no recourse, no appeal.
It feels we’ve become complacent in the west. Throughout history, childbirth has been one of the biggest natural causes of death for women. Until the 1930s childbirth was still dangerous in the UK. Most people knew someone who had died in childbirth. Childbirth is much safer now in developed countries because of advanced medicine. Childbirth is still incredibly dangerous for women and babies in the developing world where 300,000 women die every year from pregnancy and childbirth because they lack the medical technology that keeps us developed world pregnant women safe. Globally, one in every 180 women will die in their lifetime from pregnancy and childbirth. And for every one woman who dies, 20 are left severely disabled through childbirth. Infant mortality is much worse than maternal mortality, as nearly 5.5m new born children die each year, half from child birth, half from still birth. While c-sections are made out to be the devil, they’re keeping mothers and babies alive that nature would cast aside.
Yet I’m not saying c-sections should be everyone’s first choice, but they shouldn’t be demonised, nor should those who choose them.
I’m choosing a section as to me, it’s the better of two bad options. Of course I don’t lightly face serious abdominal surgery, but neither do I want to face the unknown of vaginal labour because vaginal labour may go effortlessly, it may not. No-one knows how it’ll go until you’re in the middle of it. I’ve heard one or two stories of almost immediate delivery, and I’ve heard many more stories of hours, sometimes days, of pain and difficulty, often followed by an emergency c-section. Though emergency c-sections are very common, and happen to 1 in 6 UK mothers who were told, and believed, they could have a vaginal birth, these stories aren’t normally proffered by people. They are told over time and bottles of wine.
Half of vaginal labours in the UK need medical intervention. 1 in 8 will need forceps or a ventouse – metal clamps or a plunger inserted into the vagina to clamp or suck onto a baby’s head to pull him or her out from his or her stuck position. I’d rather a c-section to either of those.
I’m choosing a c-section as besides the agonising pain, I don’t want the 90% risk I’ll tear my vagina. It’s a risk that is underplayed yet at 90% is almost a guarantee. Only 1 in 10 women who deliver vaginally will not tear their vaginas. Between 60 – 80% tear badly enough to need stitches, and 1 in 15 first time mothers tear their vaginas from front to back, so badly that they will continue to poo and wee themselves long after childbirth has ended. All vaginal tearing contributes to incontinence later in life.
Mostly, I’m choosing a c-section because I live in a world which allows me to make choices based on what I think will make my life easier and less painful. I order my groceries online, I don’t grow them in my own field. I relish central heating in my house, rather than burn logs in my hut. I use a dishwasher and washing machine and enjoy hot, plumbed in, showers at home, rather than take my plates, clothes and body to wash in a local cold lake, as my ancestors would have done. (It’s a stretch to call clothes or plates or huts natural at all – all are manmade and none are found in nature). I embrace the modern technologies that allow me to live a longer, easier and more pleasurable life, rather than try to be ‘natural’, so I don’t understand why it’s assumed I would want to be ‘natural’ in childbirth. There’s no other serious medical procedure (such as childbirth) that I would choose to face ‘naturally’. I would embrace medical advances and technology at every turn. It is these medical advances that allow us to live so long now. Left to nature, as our ancestors were, we’d live to half of our expected 80 years.
I appreciate some women wish to labour vaginally, and I respect their decision, it’s theirs to make. I just wish more people would understand and respect mine. I also wish that the pregnancy propaganda machine would give it a break when it comes to Caesarean sections. They are not more dangerous or more expensive than delivering vaginally. They are not the work of the devil. They are not something to be feared – the death or serious injury of mother or child in labour takes that crown. When you look at the real list of pros and cons of vaginal and c-section births, you see that a c-section is quite a rational choice.
I first blogged about this topic here: http://influenceofbooks.blogspot.co.uk/2016/12/push-back-by-amy-tuteur-and-me.html