Mums Accept More Risks Than Docs speaks about a study that looked at natural birthing intentions between patients, doctors and nurses. The article really has a lot of information, so I encourage your reading it. I would love to quote the whole thing, but that isn't appropriate. Here are a few excerpts:
102 pregnant women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons were included in the study. Participants were asked to rank 17 potential complications of vaginal delivery, including severe anal incontinence, severe urinary incontinence and vaginal prolapse, to determine the maximum level of risk they would be prepared to accept before opting for an elective Caesarean.
The researchers found significant variations between the groups. Just 2% of pregnant women indicated that they would prefer an elective Caesarean, compared to 11% of midwives, 21% of obstetricians, 44% of colorectal surgeons and 50% of urogynaecologists.
All of the groups ranked pelvic floor problems the highest as a motive for requesting an elective Caesarean over vaginal delivery. The risk of having to undergo an emergency Caesarean was ranked higher as a motive by doctors than the pregnant women.
It appeared that pregnant women were also more willing to experience pain in labour and perineal discomfort.
Midwives’ views were more closely aligned to those of pregnant women, while urogynaecologists and colorectal surgeons were prepared to take very low risks before they would opt for an elective Caesarean,” the researchers explained.
Commenting on the study, Prof Philip Steer, editor-in-chief of the journal where it was published, said that the findings may indicate that doctors ‘are biased by their inevitable involvement in complex cases, or labours where things have gone wrong
I was asked to comment on this specific article, I suspect because someone would think I would hurrah what they were saying.
However, I am not surprised at all by the study. Are you?
It's interesting how the study was reported, too. Barely mentioning that doctors might have a different view because of their "involvement" with the complications they see. Well, of course they are biased! What they see are the complications, the women who need help, listening as women cry and lament their experiences in birth. It must seem that so many women need help, why would anyone put themselves through all that?
OBs surely see more of the complications than midwives (who have a pretty low rate of considering an elective cesarean)... one, because they have more complicated cases, especially in Europe. I am not sure how midwifery works in Australia, where the study was performed, but if it is similar to Europe's model, I absolutely understand the myopic view of complicated birth. Secondly, doctors perform more instrumental deliveries and episiotomies than midwives (who do no instrumental deliveries) and those can cause serious pelvic floor damage. Because they see more damage (even if it is iatrogenic), they must be thinking, "I don't want that to happen to me!" and, instead of working to create a birth where damage isn't (almost) a given, they assume a cesarean will avoid all those annoyances.
The doctors interviewed also do surgery and therefore, surely are de-sensitized to the risks of surgery. It is an everyday occurence, what's the big deal? I think that there is a period of healing OBs miss - the part where there is so much pain the woman can barely function, but was told it would be normal so she doesn't call. The OBs see women about 4 days postpartum and not again until 6 weeks postpartum. A whole lot happens in that interim, including amnesia of the pain once the woman sits in front of the doctor 45 days after the birth as s/he asks if she is in pain - present tense, not past. Visits are so cursory and so focused on the immediate issue (birth control, Pap), that emotional changes/concerns are rarely addressed.
Midwives, on the other hand, see women much more frequently and certainly speak to women more than OBs. We, by nature of the profession, are brought into the woman's experience as she processes her pain and disappointment. I believe if OBs saw women in the middle of that really excruciating time, they would think differently about elective cesareans.
No, not surprised at all by the article. To women, the complications are, for the most part, theoretical and an unknown. For MDs, they know what is involved. I don't think women fully realize the implications of the complications - that anal problems can mean pooping without warning... in public as well as at home. It can mean having to physically scoop out the poop (with your own hands) every time you want to have a bowel movement. Sometimes for MANY months (or years) before surgery is able to be performed. Women without insurance or money are screwed all the way around. Incontinence can mean dribbles or flows - living in pads sucks. Not having sex with one's spouse evolves into resentment, anger and all too often, divorce. I believe if these facts were disclosed in the study, women might have thought again about an elective cesarean.
That pain isn't a huge issue doesn't surprise me. Women are strong! Docs tend to see labor as suffering, whereas most women grasp the work-benefit of it all.
Read the article and then tell me what you all think.
What would I do? If I *knew* I was going to have something, I would absolutely have a cesarean. If I had anything like I described in a previous birth, I would have a cesarean. I wouldn't schedule one... I'd want to go into labor... but I would not want a repeat of an experience that involved an enormous amount of pain and embarrassment. If I didn't know what was to come, I would have a vaginal birth - and fix whatever happened asap.
What about you?