Cesarean Choice 'Abandoned By Feminists'

My co-author, Dr. Magnus Murphy, gave an excellent interview on CBC Radio this week (listen here), explaining how "when it comes to caesarean sections, women don't have as much choice as they should."

"There are a lot of women who do feel that the feminist movement has dropped the ball on this... pelvic floor outcomes are completely ignored and that is a huge impact on a woman's quality of life over time."

How right he is.

Beneath the CBC's accompanying article, Elective C-sections are the women's health issue abandoned by feminists, says Alberta doctor, I posted the following comment:

"I am the co-author of one of the heavily referenced books cited in this article, and I am a woman and a journalist who chose a cesarean birth twice. I began working on a campaign to ensure greater balance in the information women receive in their antenatal care back in 2004, and my organisation, which is a Stakeholder for numerous NICE guidelines in the UK, was instrumental in bringing about an update to national guidance on maternal request cesareans in 2011.

I have worked closely with many other incredible women, including Maureen Treadwell (Birth Trauma Association), Penny Christensen (Birth Trauma Canada), Leigh East (c-sections.org), Janice Williams (Cesarean by Choice Awareness Network), and this is to name but a few. I've also worked or collaborated with organisations including the British Pregnancy Advisory Service, Advocacy for All (AFA), Erb’s Palsy Group, Perinatal Illness-UK, Pyramid Of Antenatal Change and AIM New Zealand, with all but one of my personal contacts at these organisations being women. Also worthy of note here is the incredible research and passion of Professor Hans P Dietz and midwife Elizabeth Skinner, at the University of Sydney, Australia, and their continued support for the (voluntary) work that I do, such as communicating with journalists and trying to help women whose cesarean requests are being refused.

Together, all of us are trying to redress the balance of information, and trying to expose the myths and untruths that are communicated about an informed planned cesarean birth choice - not to mention the lack of disclosure to women about the risks involved (for themselves and for their babies) with a planned VD.

So while CBC must be congratulated for airing such an important topic, specifically on the question of why more women are not drawing attention to the issue, I would gently point out that we 'are' all trying; it's just that our voices are not always heard or are not always given the public platform to be heard... (I have contacted CBC at least twice asking for this subject to be covered, for example).

And certainly in general, the media needs to be more discerning in its reporting of planned cesarean risks versus planned VD (although inroads are fortunately being made... here's an article by one British journalist with whom I have been in contact and sent our book to, for example: https://www.newscientist.com/article/2078853-push-for-natural-birth-a-dangerous-flaw-in-uk-maternity-review/).

Lastly, on the subject of birth research, I think readers - and journalists at the CBC - might be interested to know what Australian doctors warned back in 2003 when debating whether or not a 'cesarean delivery on maternal request' clinical trial would be a good idea. They said: ‘What a disaster it would be if it was found elective caesarean was safer than vaginal birth’ (Robson S, Ellwood D. Should obstetricians support a ‘term cephalic trial’? Aust N Z J Obstet Gynaecol 2003;43:341–3.)

Indeed.

And so we continue to see birth comparison research that ignores pelvic floor outcomes entirely (it doesn't matter if the woman is left incontinent; her VD remains a 'success' in the data compiled) and/or combines maternal request cesarean outcomes with other cesarean births that were carried out for existing or emergency medical and/or obstetrical reasons. And when the outcome data is skewed, so too are estimations of cost - remember NICE CG132 reported a mere £84 difference between PVD and PCD when (only) urinary incontinence downstream costs were accounted for.

Similarly, stillbirths prior to the onset of labour - especially those where the baby dies in the 38th, 39th, 40th or 41st week gestation - are very often not even counted in planned mode of delivery data. Don't these women deserve the choice of a planned cesarean delivery alongside the options of awaiting spontaneous labour or inducing labour at 40 weeks EGA?
I think they do.

To conclude, death and injury during childbirth is wholly natural and normal, and while thankfully in the developed world the chance of serious adverse outcomes is much lower than in the developing world, when even a <1 100="" br="" happening="" is="" it="" risk="" s="" to="" you="">
Women need to be more fully and fairly informed about the risks and benefits of both birth plans, and ultimately allowed to make their own choice, as per the 2015 Supreme Court ruling referred to in this, one of my letters published in BJOG."