Too posh to push?

THE growing demand for elective Caesarean sections in developed countries has led to the coining of the phrase, “the too posh to push crowd” and, since recently, the British government has gone as far as to set new guidelines which would allow women to get this procedure at public health facilities upon request.

But this demand for Caesarean delivery by maternal request (CDMR) has sparked a debate in the metaphorical childbirth world, as obstetricians, gynaecologists, midwives, feminists, moralists and most recently government officials, have been taking note of what is becoming an all too popular trend among the rich, famous, and not so famous.

Whereas vaginal births were the norm before and C-sections were done in emergency situations or for those women whose underlying medical conditions made it the next best thing, the tables are now turning in some countries where the number of babies delivered by C-section far outweighs those passing through the vaginal canals to enter the world.

According to local obstetrician/gynaecologist Professor Horace Fletcher, in countries such as Brazil, there has been as much as 70 per cent Caesarean section prevalence rate in recent years.

More and more it seems women in high social standing are finding the idea of lying in a delivery ward pushing to give birth unappealing, and are deliberately choosing to undergo surgery to remove the baby.

“We are not talking about a woman who requires a Caesarean section; we are talking about a woman who has absolutely nothing wrong with her, who can deliver normally vaginally, but she has opted not to stretch out her vagina,” explained Professor Fletcher who is based at the University Hospital of the West Indies (UHWI).

“We are not talking about the women who have big, big babies, or the women who have babies in distress, or the women who are bleeding and the babies need to come out immediately. We are not talking about those, we are talking about a woman who doesn’t have any problem and is perfectly normal,” he said.

Both a vaginal birth and a Caesarean section pose potential risks to a mother during childbirth, but the vaginal births have been the preferred choice since it presents less long-term risks to mother and child.

“In the United Kingdom, a lot has been written about the risk of vaginal delivery and the risks over there have to do with incontinence, so they say it is better you deliver the woman abdominally because you have a lower risk of urinary, rectal or anal incontinence when you deliver them abdominally,” explained Professor Fletcher.

But the risks posed by a C-section, Professor Fletcher said, are even more life-threatening for both mother and child. He said it poses anaesthetic risks, intra-operative risks leading to damage of the other structures around the uterus like the bladder and the bowels, and there are also operative risks such as thrombosis, bleeding and infection.

“You have to weigh the pros and the cons,” said Professor Fletcher, before pointing out that,”Some women don’t want to go through the pain of labour, but you can use an epidural anaesthetic and inject them around the spine and they have no pain when they are delivering the baby.”

Apart from the complications listed above, Professor Fletcher pointed out that a Caesarean section results in women being in pain for much longer following the delivery. There is also a risk of the baby being cut during the procedure which the gynaecologist said he has seen a number of times.

“When you are delivering the baby, sometimes the uterus is much thinner than you expect and when you make the uterine incision, if you are not careful, the baby’s head is right there and the baby can get a cut,” he said, while adding that the woman also loses more blood during this procedure than with a normal delivery.

CDMR is not common in Jamaica where according to Professor Fletcher, at least 30 per cent of births at the UHWI and about 15 per cent of births at the Victoria Jubilee Hospital in Kingston are C-sections. And while studies in the UK in particular have shown that delivering a baby vaginally affects the pelvic integrity and results in incontinence, the same does not apply to women here.

“I can tell you categorically that the same thing doesn’t necessarily apply to Jamaican black women because the risk of genital prolapse is lower in Jamaican women; this is factual. In the United States, most of the Caesarean sections done are for prolapse in white women. In black women, most of the Caesarean sections that are done are for uterine fibroids, so it’s two different things you are looking at,” he said.

For his part, Professor Fletcher believes C-sections should only be a last resort.

“You can never tell [what will happen] once you cut somebody’s belly and go inside. I believe very strongly that you should have a good indication to actually go ahead and do something like that,” he said.