Caesarean births: how many are unnecessary!

Press, 23 September 1980, Page 12

Caesarean births: how many are unnecessary!

DR CELIA DEVENISH,

of the Christchurch

Clinical School’s department of obstetrics and gynaecology, reviews a new United. States publication by Diony Young—formerly of Christchurch —and Charles Mahan. .“Unnecessary Cesareans: Ways To Avoid Them” is published by the .International Childbirth Education. 27pp. She also;: looks at Mrs Young’s earlier booklet, “Bonding.” *

In the recent decades, the safety of childbirth, both for mother , and has become, an expected foetus, Today’s desire, is for quality . of the birth experience, and a request for an individualised approach to. problems. Surely these are reasonable expectations, so long as the safety of childbirth is not jeopardised. But it would seem that this might not always be the case. “Unnecessary Caesarean Sections” is written from within the American system of health care, where medic o-legal pressures ensure .the practice of defensive obstetrics. In response to this, consumer parents have become more vocal in assuring- what they consider to be the optimal birth circumstances. This book aims to make the public better informed. The authors are particularly concerned about what they consider to Le a large number.-: of unnecessary, caesarean births, in the United . States.-; New Zea/ land’s rate;"is < now about eight out of every 100 births. The fate in America is almost double that. Whilst no publication can turn even the best motivated lay person into

an expert, al familiarity with obstetric- principles and , terminology, does allow' discussion on common ground. The evolution of caesarean births, and the circumstances which may necessitate them are described here in some technical detail. The writers go a step further by itemising the steps a patient can take to ensure she has attendants who are sympathetic to her preferences in her particular complication. The support of independent parent ■ • education group’s is encouraged, as is a quietly questioning attitude. ’ - New Zealand obstetric practice -S differs- quite markedly from that hi the United States of America in. some important ; respects-. For instance, “social” or “convenient” induction of labour is -in my experience ; virtually nonexistent here. Trying first a vaginal breech delivery, labour, a single, previous caesarean scar would be the normal practice given no -: v-additional complications.; :• For such trials are most likely to succeed under Epidural (local anaesthetic around the spinal nerve), anaesthesia, a point not

mentioned by the writers. Moreover, correctly managed Epidurals need not increase the rate of operative delivery; indeed in the difficult posterior position they may allow spontaneous vaginal delivery which might not otherwise be feasible. Caesarean sections under Epidural allow the parents to participate in the birth. So I cannot agree with the section which condemns all Epidurals as unwarranted interference. ’ . Allowing these qualifications, the writers give us a helpful format, which is presented well, with extensive references. One should remember that the careful obstetrician must . continually weigh the balance for and against intervention. The foetus and/or the mother at risk represents a grey area which should be trodden with discretion and with appropriate explanations. If the writers achieve this aim, then' their book should be considered a success. “Bonding” is an earlier publication, written .. in gentler tones. It helpfully describes ; the. advantages of a couple exploring their infant from the first moments of-1 irth by . continuing close contact,, and accessibility to the family circle. - •* This natural instinct would seem to have been hindered in ■ the recent past by medical and midwifery practices. But since it is only the-, shocked, infant tfrat/nqeds minimal handling-' rather' than the mother’s arms, natural bonding should become such common practice ."as ,to make it unremarkable.