Sunday, November 11, 2012

Maternal request cesarean a "societal and professional failure"? I don't think so

Readers of this blog may recall an earlier post in which I reported the reason given by Lamaze International's journal Birth for declining to review our book, Choosing Cesarean: A Natural Birth Plan. Reading no further than the book's summary, our publisher was told, "The content of this book does not match the philosophy of our journal."

It may come as little surprise therefore to read this article by Professor Michael C. Klein, which was published in Birth last week:Cesarean Section on Maternal Request: A Societal and Professional Failure and Symptom of a Much Larger Problem

I have only accessed the online Abstract so far, and incredibly, while the author appears to acknowledge evidence of worse pelvic floor outcomes with vaginal delivery ("Sultan et al's impressive rectal ultrasound studies... showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section"), and the fact that a "growing number of birth practitioners are choosing cesarean section for themselves - usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues", he blames this choice on "a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth".

The abstract, which is due to be published in the journal next month, continues [my bold], "Cesarean section on maternal request is a complex issue based on fear and misinformation that is a symptom of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal.

"Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work—it requires a complete refit."

My view: There is so much that I could write here in response to this 'vision' of how the future of maternity care should look, but fundamentally, I come away feeling that it's Professor Klein (and others like him) who may be fearful - fearful of informed women making decisions (and being happy with those decisions!) that do not fit in with his personal and professional beliefs.

Question: Why don't natural birth advocates focus on supporting women who WANT to have a natural birth, instead of advocating this birth choice for ALL women - and assuming that those of us who choose a cesarean must be afraid and misinformed?

I felt completely empowered, informed and happy with my cesarean choice - but as long as Birth's editors decline to read our book and understand this perspective, I guess it will continue to publish articles just like this one...


Anonymous said...

Professor Klein's entire career has been based on ideology. The women of British Columbia (where he was influencial in training a generation of OBs, Family Docs and RNs in maternity care) have sufferred because of him and it's going to take years for the damage to be undone - for the women of BC to uniformly have access to the entire range of informed childbirth choices. Right now there is a plethora of ideology, a shortage of anesthesiologists and a system that thinks nothing of denying someone a maternal request c-section.

This is the province that has the "power to push" campaign - started with the explicit goal of lowering the c-section rate. They have special clinic (the better birth or best birth clinic can't remember) that exists to "council" women that request c-sections, women carrying breech babies and VBAC candidates. I wonder what they recommend hmmm?

Mrs. W. said...

Here, here. But to be fair, 'Birth' isn't so much a scientific journal as it is a compendium of natural birth advocacy opinion pieces.