A fortnight ago, I heard about the latest ESRI report on the fertility of Irish women. It’s taken me a while to address the most disturbing statistic revealed in that document, but I’m finally getting around to it.
Caesarean section rates in Ireland have increased. They are steadily creeping up and now stand (or lie!) at almost 25%. Bearing in mind that the WHO recommends that the C-section rate should not be more than 15 percent in any country – least of all a developed one where difficulties associated with vaginal birth, like malnutrition and FGM resulting in damage to the birth canal are virtually non-existent.
The day after these figures were released, I heard Peter Boylan of the National Maternity Hospital in Holles Street giving reasons why we are now more than ten percentage points above the recommendations of the WHO. I was just going to tweet ‘There’s Peter Boylan talking bollocks’, but I decided instead that it might be more useful to deconstruct his argument.
Boylan’s main arguments for the rising increase revolved around the following:
1. We now have women who are ‘much older’ giving birth for the first time.
2. There are more IVF babies.
3. Breech presentations lead to more C-sections.
4. Women have a ‘natural tendancy’ to worry about their pregnancies and think that anything that can go wrong will go wrong.
Unfortunately, none of these ‘reasons’ is an evidence-based reason for cutting women’s abdomen’s open in order to extract their babies.
That Irish women are ‘much older’ giving birth for the first time, is an interesting piece of demographic research – not a reason to insist they undergo major surgery! In a search of scholarly articles, I could not find a single shred of evidence to suggest that being over 35 or even over 40 was in and of itself a contributing factor to risks that would necessitate a C-section. Not one.
As to Boylan’s assertion that IVF babies are more likely to ‘need’ to be brought into the world via surgery – there is no evidence to suggest that a pregnancy achieved through IVF does not proceed exactly the same way as every other pregnancy. Therefore, there is no evidence to suggest that any more than 15% of these births should be ending in Caesarean-sections.
Breech presentations, as any good midwife knows, are a variation of normal. A breech birth, therefore, is a ‘normal’ birth and should be treated as such. The problem is that the knowledge and skills necessary for attending a breech birth are being lost and ‘normal’ is regarded as ‘dangerous’.
I don’t think any of Peter Boylan’s ‘reasons’ for the rise in C-sections is quite as arrogant, condescending, patronising or stems from a more patriarchal place than his assertion that ‘women have a natural tendency to worry about their pregnancies and think that anything that can go wrong, will go wrong’. Women don’t have a ‘natural tendency’ to assume that their pregnancy is doomed from the outset. We don’t need a doctor to pat our hands and tell us that they’ll take care of everything for us! Women, in fact, don’t worry about anything until it is suggested that there is anything to worry about. And who plants these seeds of doubt and worry? Why, the doctors, of course.
If, as Peter Boylan was suggesting, these natural worrying tendencies of women are responsible for the rise in C-sections, I wonder where he feels the responsibilities of doctors lie? Should they not be reassuring women with actual, cold, hard facts on the outcomes of pregnancy and childbirth? Should they not be reassuring women that pregnancy and birth are perfectly normal, everyday occurrences? Should they not be informing women that the outcomes for then and their children are better if they just allow nature to take her course?
In her piece in the Irish Times on June 26th, Dr. Jacky Jones reminds us that ‘Fooling ourselves that the birthing process is safer for women when doctors are in charge is the ultimate example of group-think. The vast majority of women are able to give birth without surgical intervention so doctors are redundant except in about 10 to 15 per cent of cases. Obstetricians spent the 20th century inventing surgical and mechanical ways of interfering with a natural process to ensure they were not redundant.’
Unfortunately for women and their babies, Dr. Jones is right. I don’t want to vilify all doctors; they’re not operating from a place of greed many of them genuinely believe that they have women’s best interests at heart; but they forget that they are trained in the ‘abnormal’. Their expertise is in intervention when things go wrong. As women have increasingly handed over their power to male doctors – and female doctors trained in a medical model that was invented by men – the amount of intervention in normal births has increased.
Dr. Marsden Wagner, who was formerly the WHO’s Director of Women’s and Children’s Health, wrote about this phenomenon in his seminal piece ‘Fish Can’t See Water’ which points out that because doctor’s don’t know any better, they can’t do any better.
It makes me very, very sad that women are continuing to hand over their power in this, the most feminine of arenas, to men. Until we stand up and wrest our power back from the patriarchal system that Birth is embedded in in this country, we can never truly expect the lot of women and children here to improve. As long as we are happy to be compliant, we will continue to be complicit in our own subjugation.