Friday, October 24, 2008

Sometimes it takes a celebrity to get the point across

It's funny world. In the past, I've read media articles accusing women who choose cesarean delivery of being 'celebrity copycats.' Even medical professionals have pointed towards celebrity culture as one of the reasons for the rise in cesarean on maternal request; women want surgery because they see their celebrity idols having it. This idea is also behind the name-calling trend, 'too posh to push', which refers to the specific influence of Victoria Beckham.

The fact of the matter
First of all, there is no evidence to suggest that women are merely 'copying' a celebrity culture when they choose to have a cesarean. Instead, maternal questionnaires cite fear of labor, avoidance of pelvic floor damage and a tolerance for the risks of planned, controlled surgery in preference to the more unpredictable risks associated with vaginal delivery.

In fact it is the media itself that is influenced by celebrity when it comes to reporting on childbirth. If a celebrity speaks out about a negative cesarean experience, this makes the headlines. If a celebrity describes a preference for cesarean delivery over vaginal delivery, again, their story is given center stage. Just this week, the British singer and actress Billie Piper gave birth to her son Winston by emergency cesarean after a reported 26 hours of labor. Her boyfriend is quoted as saying it was "a major thing' but it remains to be seen over the coming days whether newspapers and magazines take the stance that it's another negative cesarean story or whether it's a negative planned vaginal delivery story. My guess is that Billie Piper's first comments to the press will decide that.

Celebrity experience counts
Take for example Gwyneth Palthrow; she described how difficult she found labor with her first baby, Apple. On the flip-side, there was Davina McCall who described a very positive vaginal delivery experience. Then there was Christine Aguilera, the first celebrity to admit to planning her cesarean through her own choice due to a fear of vaginal delivery. Before that, Kate Winslet admitted that she had lied to the media about having a cesarean delivery because she was concerned about the negative press she might get.

The good thing about all these stories is that they keep the issue of childbirth in the public eye; they remind us that childbirth is not always straightforward, that there can be a whole range of experiences from good through to bad, and that we should be more tolerant of the decisions of women with different perspectives and desires than our own. And while I think it's a shame that we have to rely on celebrity news coverage to shine the spotlight on maternal autonomy, I'm also hopeful that by doing so, it acts as a catalyst for media discussion (online, in newspapers and magazines, on the radio and TV), and ultimately leads to greater access to information for women planning their births. That's the very best we can hope for.

2 comments:

Apple said...

Kate Winslet by her own words was ashamed of having a c-section.

Cesarean does not prevent pelvic floor damage BTW. I'm reminded of a certain study conducted amongst nuns (no childbirth, no sex, no nothing) that found similar rates of incontinence and pelvic floor problems as their Motherly counterparts regardless of delivery type.

cesarean debate said...

I must correct you. In fact a large number of medical professional (and indeed medical studies - see my website page on 'Birth injuries' in the 'Vaginal delivery concerns' section for more details) have stated that protection of the pelvic floor is perhaps the most important benefit of planned cesarean delivery.

That is not to say that all women will experience physical damage during (or indeed following) vaginal delivery, but it is more likely to occur than during a planned cesarean delivery.

There are two studies on nuns that I am aware of, one in 2002 (http://www.greenjournal.org/cgi/content/full/100/2/226) and the other in 2005 (http://www.greenjournal.org/cgi/content/abstract/106/6/1253).
You can read the details via the links, but the important points to note are these:

1) The studies only measure prevalence of urinary incontinence. They did not ask the women about any problems with fecal incontinence or pelvic organ prolapse for example.

2) Most importantly. The women questioned were of a very mature age. They are described as having a 'mean age of 68' in one study and 'postmenopausal' in the other. It is well established that the incidence of urinary incontinence generally increases with age, regardless of parity. The question researchers need to ask is whether vaginal delivery is associated with an increased prevalence in women of childbearing age (e.g. the age groups 20,30 and 40 years-old), at a time in their lives when incontinence is NOT to be expected. There are nuns of this age available for questioning and I think that the results of this type of research would be more appropriate.