There has been considerable discussion on the issue of elective C/S
here, to the point of even having a conference about it.

The position taken by women is that going into labour is too uncertain.
Women want to know when they are having the baby so they can put in in
their Daytimer, their partner can pre-book time off and their families
can too, including arranging flights, etc.  Labour is just not
convenient.

Articles in general magazines generally talk about labour that turned
into horrendous experiences and compare them with totally uneventful
C/S.  Naturally they don't compare the natural births that are
"unremarkable" with C/S that end up with mom having an anaesthetic
reaction, baby arriving blue and a wound infection that confines mom to
home for weeks (we had a series of referrals like this a few months
ago).  So, the perception is the C/S is nice and controlled.

A couple of physicians' organizations have stated that C/S is just as
safe, if not safer, for babies (BF is NEVER considered in that).  They
also say that the longer postpartum stay cost is balanced by reduced
one-to-one nursing for labour.  <aargh!>  How many docs are doing this I
don't know, but we have a shortage of docs who actually do deliveries,
and a shortage of midwives as well.  Of course C/S can be confined to
work hours (mostly)...  Our local C/S rate is the highest in this
country.

As for pain... We have a very high epidural rate.  Now I KNOW that's
partly physician related, but it's also nursing staff related:
comfortable women are less demanding that uncomfortable ones and (guess
what!) there's a nursing staff shortage as well.  Nonetheless we
constantly hear things like "I was only 3 cm but the nurse said that the
anaesthetist was on the floor and I might want to have an epidural now
because s/he might not be available later IF you need it"  Conversely
the folk in prenatal classes are basically there to learn what to do
UNTIL they get the epidural.  

Twenty-five to thirty years ago we fought for decreased interventions.
Now we have them all back (some the same, some different).  They've been
sold in the same way as formula:  birth with epidural is just as
good/safe/healthy as natural; birth by C/S is just as good/safe/healthy
as natural and more convenient to boot.  

Can you say frustrated?

Judith


Judith Hayman, RN, IBCLC, BSc, BScN
Public Health Nurse & Lactation Consultant

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