What's the point of midwives? Wouldn't it just be safer and easier if everyone had a caesarean?
A mate asked me these questions over wine the other night and the poor love wasn't looking for the lecture that came her way! I understand where these questions come from though. We try to control everything from relationships to careers and Western society does not embrace being out of control. Labour and birth however are uncontrollable, and this doesn't have to be a bad thing!
At first glance it can appear that having a scheduled day with a group of obstetricians and trained nurses might be less risky than an unknown number of hours in labour followed by pushing your baby out through the birth canal.
However, a caesarean is major abdominal surgery, and though relatively safe needs to be taken as a serious decision.
On the most basic level I look at it like this: if you give birth naturally there is a good chance of coming out of it with no damage at all, and there are tips and tricks to help with this! With a caesarean you are guaranteed a surgical incision in your abdomen.
There's nothing better than a caesarean if it's really needed, are there are a few emergencies where this is definitely the case. I have loads of respect for obstetricians, not least because I know I'd hate to make the kind of decisions they have to - but in my opinion they are trained to eliminate risk if at all possible rather than control it.
This kind of medicine is ace if you have had a car crash and saves a lot of lives. However from the perspective of birth and labour it can be rather aggressive.
How birth works:
It's all to do with the hormone oxytocin. This is the same hormone that comes out when you feel safe and loved, and during sex. It's the cuddle hormone. It also makes you have contractions when you're in labour, and amounts peak as your baby is born.
Oxytocin can be scared away by any anxious emotions which make adrenaline hormones. In evolutionary terms this was very useful as labour would stop if you were being chased by a lion or hiding from something scary. It means people often labour better in comfortable environments. It's classic for a labour to start and Mum to turn up at the maternity suite only to find her contractions knock off because her body is nervous of her surroundings.
It's the same principle as arousal: imagine having good, intimate sex with your partner. If someone was to come into the room making loud noises with technical machinery, start asking for your post code and taking blood or other uncomfortable procedures, the odds are your arousal would drop (unless your into that kind of thing, in which case fair play!).
Your body producing more oxytocin means faster, smoother labours, easier descent of the baby, and basically less chance of things going wrong.
Birth comes with natural endorphins to help with the pain of contractions. Have you ever worked out really hard and felt a satisfied glow afterwards? There is a similar feeling between contractions for a lot of women.
You also get breaks of a few minutes between contractions where most women feel absolutely fine. It's challenging, but for almost all the women I've looked after in labour, their bodies did not chuck anything at them that they couldn't handle.
Problems with caesareans:
I've put together a chart above (because I'm having fun playing with photoshop type software) which shows the World Health Organisation's most recent data on a global scale. The increased risks include: maternal death, admission to intensive car, and blood transfusion or hysterectomy within seven days following delivery, fetal death, neonatal mortality in the first week of life if in hospital, and stay >7 days in neonatal intensive care.
Caesareans are also expensive, and also contribute to the mass use of antibiotics worldwide which is causing resistant infections.
In a recent COCHRANE review (who do massive reviews of all good data) they found that elective caesareans are much more likely to cause maternal death; the UK as example had 20.6 women die who gave birth vaginally out of a million, compared with 58.5 who had elective caesareans.
Some smarty pants might point out that women who have elective caesareans might be more at risk anyway - but COCHRANE's conclusion say they adjusted for these factors and that caesarean section has inherent risk.
The data doesn't apply to all birth, as breech (bottom first) birth, and some emergencies have totally different outcomes, so you have to get data for your specific circumstances.
Why not to get worried:
The odds of getting seriously damaged when having a baby anyway are small. Something i was reading recently about driving I seem to recall said 71 death/million cars, so that's more risk than an elective caesarean.
It's just knowing about labour and birth is important for your health in the same way as knowing brushing your teeth prevents cavities and eating fruit and veg prevents cancer. It's basic info everyone should have access to easily and feel empowered to make decisions by.
What's the point of midwives?
Midwives are there to facilitate normal vaginal birth, give pain relief if you need it, and generally give you the support you need to power through this challenging but rewarding event. A midwife you've known through your pregnancy is your own home is much more likely to increase oxytocin levels rather than scare them off.
They are also know all the tips and tricks like hot showers, back rubs, music, positions and so-on which have worked for other women. Doctors just don't have these things and are more likely to assess a problem, and treat it, which is brilliant if there's a problem but not so good for normal, if challenging labour.
A well-trained midwife will notice anything abnormal and know when to get a Doctor in.
Isn't it all more complicated than this?
Definitely. There are lots of factors involved, just like with cancer or getting to peak performance as an athlete, and all the other physiological stuff humans get up to, it's never clear-cut. However these are the basics of how birth works.