This article is causing some profoundly mixed emotions for me. On one hand, it's truly fantastic that the NSW government (that's New South Wales, the most populous state of Australia for non-Australian readers) has acknowledged that not only is the rate of elective caesareans increasing but that it is also possibly endangering the lives of women who are uneducated about the procedure.
However, I have strong feelings about taking women's responsibility for their own bodies away from them and giving control over to the government to decide what is best for birth. Clearly, major abdominal surgery is a significant leap from vaginal delivery but is it really fair to insist that women must not have a technologised or interventionist birth if that is what they really want? Sure, some of you might say 'Well, how does she know what she wants if she doesn't know the risks?' That goes without saying but adult decision making is kind of like that. We make decisions about lots of things without knowing all of the associated risks. With birth, it seems like everyone seems to know what's best for pregnant women except women themselves.
We dont have to agree with the choices other women make but I think we need to respect them. I might not choose to have an elective caesar but I don't think my choice not to have one should prevent another woman from having one if that is what she feels comfortable doing. I think it would be a completely different story if for instance, the NSW government decided to ban women from having pain-reducing drugs during labour because pain relief is non-surgical. All of the most common pain killing drugs have side effects and there is plenty of research to support that. Hell, epidurals are injected into the spine. That's a major risk; but women who want to have less pain in labour should never be forced to 'suffer' needlessly and many women are willing to take a risk to be comfortable. I think this is the same issue. Maybe it seems a little strange to some of us that a woman would rather have surgery than give birth vaginally but in my own work, I have interviewed a number of women who have had elective caesars for various reasons. Fear of pain is a primary reason and who can really fault them for that? It's not my place to do so and it's not the government's place either. Women need to make up their own minds about how they have their babies. Caesareans should remain an 'option' because women should have every opportunity available to them to have a comfortable birth and if that means being cut open, who am I to judge?
Caesars can either serve or impair women's agency not so much by the inherent character of the procedure (in terms of obvious physical risks), but in how the politics surrounding elective caesareans coalesces with the needs of variously situated women (economically and politically and also varying by race, class, and sexuality). What is 'good' for some women is not necessarily appropriate for all women.
NSW hospitals move to block caesarean option
7 April 2007, The Age
WOMEN will not be allowed to insist on caesarean deliveries in NSW public hospitals without a medical reason, under a new health department policy. Under the new rules, women must be told in detail about "the benefits and risks of caesarean section compared with vaginal birth specific to the woman and her pregnancy". The policy cites a US study of more than 5 million births, which found that babies born by medically unnecessary caesarean were three times as likely to die in the newborn period as those born vaginally.The new policy also obliges health professionals to advise women about the implications for subsequent pregnancies. A 2005 study of 136,000 second pregnancies across NSW found those women who had had a caesarean first delivery were at much greater danger of a ruptured uterus, hysterectomy orinfection, while their babies were more likely to be premature, have serious breathing problems or need intensive care. Elective caesareans have increased by 25 per cent since 2001, and now account for one in six births. Many of these are for medical reasons, but doctors say more women are opting for caesareans from preference. Andrew Child, a member of the NSW Health Maternal and Perinatal Committee,which drafted the directive, said that while first caesareans were generally safe, dangers escalated steeply with subsequent births. Hannah Dahlen, secretary of the NSW Midwives Association, said: "People are... thinking of it as just another option for birth, rather than major abdominal surgery."JULIE ROBOTHAM
