This is a post I have agonised over. It’s a post I have debated even publishing. I have gone over every word and sentence with a fine-tooth comb. Why?

Because it’s about what I think of the maternity system in Australia at the moment.

Let me be clear: by “maternity system” I don’t mean pregnant and birthing women. I mean the people, procedures, and outcomes you are likely to encounter when you find yourself pregnant and about to give birth. Unless you choose a home birth, and I think it’s pretty safe to assume that’s not very likely (0.7% of all births in NSW in 2009).

I have been wanting to discuss this for years, but as soon as I express my opinion I seem to offend someone. I just want to say clearly and loudly: I DON’T JUDGE YOU FOR HOW YOU HAD YOUR BABY. It’s none of my business. Whether it was fast and furious, long and drawn out, induced, water birth, home birth, active birth, or a caesarean. Really. I promise. I’m happy as long as Mum and Baby are happy. And I couldn’t care less how many drugs you may have had. I have had two epidurals, pethidine (once), and gas & air (twice). So obviously I have no issue with that.

What I question most are the following: the need for specialist care for low risk women, a lack of unbiased and scientifically researched information, and the rising rates of elective caesarean.

Let’s look at the facts.

1. An obstetrician is a specialist. He or she specialises in abnormalities, complications and risks that occur during pregnancy and/or birth. This is what he/she studied. This is what he/she was taught. Obstetricians don’t actually study, learn, teach, or even witness a whole lot of natural, no intervention births. Because throughout history that’s been a midwife’s job (lay or trained). So while an obstetrician is the person you want when something is wrong, so a midwife is the best person for the job when all goes smoothly. Pre-natal care is intended to monitor the health and well-being of mother and baby, and also screens for any possible complications.

So in theory a midwife would be the best person to care for most healthy low risk women during pregnancy and birth.

2. The information booklets you are given by your hospital and carers is all slanted towards hospital birth, where things like induction, episiotomy, caesarean, and epidural are ROUTINE. They don’t tell you that when it comes to having a normal vaginal delivery (meaning no forceps or ventouse), only 58% of women manage this (65% in public, 46% in private). Only 40% of women begin labour spontaneously. About 46% have an epidural. The most frightening of all is that in NSW in 2009 only 24.6% of women went home with an intact perineum (no episiotomy or tear).

Why are women not informed of these statistics? Because there is absolutely no scientific proof or research to back up these routine procedures.

3. Caesarean rates are sky-rocketing. I think that should concern us. Are women unable to give birth all of a sudden? Why do 40% of women in private hospitals need a caesarean? (NSW Mother & Baby Survey 2009. Preliminary studies shows that as of Dec 2011 the rate in private hospitals is at approximately 45%). Why are so many women accepting this? At what point is someone going to say, stop. Enough. This can’t be right.

Because it’s not. Caesareans are being performed on vulnerable and trusting women at a time when they will do ANYTHING to ensure a safe healthy baby. A woman will say “just save my baby. Do whatever you need to”. And the OB’s know this. And they use this. Just to be clear, it’s not the true emergency that I have issue with. (It’s interesting that the emergency c-section rate has not changed from around 10% in over 25 years). What irks me is the way they keep finding more and more reasons to justify their (very profitable) attitude.

Now I know many women that I love and care about, who for various reasons have had a caesarean. I want you to know: I AM NOT IMPLYING that you, your husband, and doctor made the wrong decison. I am just saying that there has to be something wrong with a 40%-45% caesarean section rate. As a society, and as women and mothers, we must question this.

Hate me yet?

I believe that the way we care for and treat women as they birth says a lot about us as a society. We need to step away from the technology for a second to remember that most of the time birthing is pretty straight-forward. (And when it’s not, help is nearby). We might be going too far when we start creating situations where only half of pregnant women will give birth to their baby with no intervention or technology. Women’s bodies ARE good at birthing, and the cliche that it’s what they are designed for is actually true. Instead of hospital brochures I would like women to be given suggested reading lists which would include lots of positive birth stories, as well as input from midwives, obstetrician’s, doula’s, and fathers.

I have found this post so hard to write because I don’t want to offend a single woman or hurt anyone’s feelings. When a new baby joins a family and we meet them for the first time all we feel is joy and excitement. We are not thinking about HOW they entered the world. After my first long and difficult (typical hospital-managed) labour I never thought anyone could possibly ENJOY labour. I thought it could only ever be something you just grit your teeth and got through as best you could. But the truth is that it doesn’t always have to be like that.

Sometimes it can be magical.

And not just the moment of birth, when everything that came before is swept away. Meeting the perfect midwife for you who turns the lights down, puts the radio on and leaves you to it. Being the only labouring woman on the ward in the middle of the night. Catching your own baby while the midwife watches.

Carers who respect YOUR intuition. That should be every woman’s birthright.

*Here is the link for the NSW Health Mother and Baby Survey 2009, as well as a list of some books you won’t find in the book shop next to “What to Expect When You’re Expecting”:

-Birth Matters, by Ina May Gaskin

-Pushed, by Jennifer Block

-Spiritual Midwifery, by Ina May Gaskin

The Birth Wars, by Mary-Rose MacColl

-Birth Reborn, by Michel Odent

-Heart and Hands, by Elizabeth Davis

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