We’ve heard my birth stories and looked at what birth looks like on television. Now it’s time to look at the real nitty gritty statistics, and find out what they say. I will be focusing on the state of NSW, Australia, and the data comes from the NSW Mothers And Babies Report 2009, the most recent year available.
Facing the birth of her baby is a monumental task for every mother to be. It doesn’t matter how many babies you may have had, in some way you are always entering the great big unknown. Anything is possible. I know one woman who had four straightforward vaginal deliveries and then had an emergency c-section for her fifth. You just never know. Sometimes we look to our own mothers and sisters as a clue, but most of the time we cross our fingers and hope for the best. So according to the number crunchers, what might your labour be like in NSW? Well, when it comes to how your labour begins, 40.7% of women had a spontaneous onset of their labours, with a further 16% having a spontaneous onset boosted with prostaglandins, artificial rupture of the membrane, or an oxcytocin drip. Just over 25.7% of women were induced using various combinations of induction methods. The most common reason for induction is still “prolonged pregnancy”, or being overdue. When we factor in elective c-sections, it seems hard to believe that only about 60% of pregnant women begin labour (or labour at all) without intervention. What seems largely forgotten is that the due date is an estimate, and with extra monitoring it is usually safe to bide your time. Although to be honest, after a long pregnancy and the discomfort of the last weeks it is often no doubt the women themselves driving the inductions. As for pain relief, 45.9% of women had an epidural, 59.3% had either gas and air or an intramuscular narcotic (e.g. pethidine), and just 10.6% had no pain relief at all.
We all like to feel unique and special, but sometimes our governments like to reduce the population down to a bunch of statistics in order to gain a clearer picture of who we are. Birth statistics are no different. Sure, in that labour room with my fourth child no-one and nothing else existed, but on paper we were just one of the 94,864 babies born in NSW that year. And when it came to where those births happened, we were one of the whopping 99.2% of babies born in hospitals or birth centres. This includes planned home births which transferred to a hospital. Only 0.2%, or 231 babies, were born at home in 2009. There were also 512 (0.5%) babies born before arrival. This last number interests me, because in theory these are the babies who were too speedy to wait for medical help. However, I wonder how many of them were part of the growing number of women choosing “free birthing”, whereby a pregnant woman shuns all medical assistance and usually delivers at home with only her partner? Anecdotally, the number of women going down this road is growing as more and more women are priced out of independent midwife care and home birth.
So as well as where our babies are born, just as important is how they are being born. In NSW in 2009 just 58.6% of women had a vaginal delivery (including vaginal breech births). Just over half of the births that year. If we add the women who were helped along with either forceps or vacuum extraction the number rises to 69.8%, which is somewhat better. I still think that a lot more than 70% of Australian women are able to birth vaginally, as this still leaves the 30% of babies born surgically. Far more than the recommended 10% c-section rate suggested by The World Health Organisation.
If we look a little further at birth, and break it down between the choice of being either a public or private patient, it begins to get more interesting. It has long been accepted that there are more interventions in being cared for by your own private specialist. If you want to avoid questionable interventions you go public. So what do the numbers show? Well, when it comes to vaginal birth 65.6% of women in public hospitals will achieve this with no assistance, while in private hospitals the number drops to 46.7%. When it comes to forceps and vacuum extraction, 9% of babies will be born this way in a public hospital, while if you’re in a private hospital it’s 14.5%. If your baby is breech and your hoping for a vaginal birth, in public hospitals in 2009 an impressive 278 breech babies were born vaginally, while in private hospitals there were just 99. When it comes to pain relief there are a couple of private hospitals that have epidural rates of over 85%, while the average in public hospitals is around 40%.
But it’s the c-section rates that speak volumes. The statistics are broken down into elective (planned prior to labour) and emergency (decided after labour onset). The emergency rate between the two is very close: 11.8% in public and 13.8% in private. If we consider that the specialists working in a private hospital are more likely to have been caring for high risk pregnancies then the slighter higher number makes sense. But the elective rates tell a different story: 13.5% in public and 25.6% in private. So if we are well off enough to afford private care, are we suddenly too posh to push? I don’t think so. This is where I believe the policies of the individual doctor come into play, and I have no doubt that some doctors prefer the convenience of scheduling a c-section to fit their busy timetable.
What do you say to someone you love who is having her second or third child and seeing such a doctor? After one c-section for various reasons like “you seem exhausted”, and “I don’t think you will be able to have this baby vaginally, it’s too big” (it wasn’t), she tells you she is desperately hoping for a vaginal birth this time. She returns to the same doctor who sectioned her first baby, because he’s “the best” in the area. Each month the doctor tells her all is well. Until sometime in the last couple of months he starts planting seeds of doubt in her mind. He comments that the baby seems to have a large head (average size on birth), that it looks like a whopper(no, average again), that her blood pressure is a concern (even though it is within normal range). Until finally somewhere at the thirty-six week mark he flat out tells her that she needs to have another c-section. He informs her that she is unable to have a vaginal birth. He tells her about uterine rupture and scares her right into the operating room. He collects his money, is done in a hour, and she is left to recover from another surgery. Am I generalising? Being too simplistic? No, I am not. This is what happens.
I understand that there is a lot more at play than statistics. A woman about to have a baby is not a mere number. What does my head in is that so many of us are just so bloody accepting of what the doctor says. We think that because we pay for the best care, that they can’t be wrong. I hate to get on my soapbox because I don’t want to offend any woman by making her think that I am judging her for how her baby’s birth took place. But I am so bloody angry at seeing women having their first baby having more and more c-sections and not questioning it. Or worse, being scared into it and thanking their lucky stars the doctor saved their lives.
It’s not life threatening to vaginally deliver a large baby. It’s not life threatening to deliver a breech baby vaginally, although unfortunately there are few doctors with the skill for this. It’s not life threatening to deliver twins vaginally if all their vital signs are good. It’s not life threatening to allow a woman in labour a little more time. It’s not radical or irresponsible to question your doctor. Although if I wanted to be radical I would state that men only started becoming obstetricians when they realised there was money to be made. They very swiftly pushed midwives aside and came up with a whole new birth plan for society that included all the interventions they could dream up. So there, call me a radical, I don’t bloody care. No midwife ever would have come up with twilight sleep. Or episiotomy.
So what the statistics tell me is that we have lost our way. We have strayed too far from nature’s plan, which gave us all the tools already on board to birth safely and happily. But, stop the presses: I am not against the idea of obstetricians. Yes, we need obstetricians. We need c-sections for those times when Mother Nature had a bit too much wine and planted an over-sized melon in Mum’s pelvis, or for those times when a cervix still hasn’t quite figured out what it’s supposed to do after almost two days. We want an obstetrician around when there is genuine fetal distress and we need that baby out now. But we don’t need them to do everything for us that we can do ourselves, with the right encouragement and support. I accept and understand that not every woman can have a vaginal delivery, but I’m pretty certain more than seventy percent of us can. Our dependence on the specialists is coming at a high price. Why are so many women being cared for by specialists who are trained in identifying and treating complications and abnormalities? It just makes no sense. In no other area of medicine would we be referred to a specialist without a definite need for one.
We have to ask ourselves: what will the future hold for our daughters?
And do we care enough to try and make a difference? Of course we do.
So let’s work on education, and let’s ask for, no, let’s demand real evidence based care. It’s not asking for too much.