After decades of ushering babies into the world by the surgeon's knife, who knew C-sections could still stir up such controversy? But when word got out last week that the major abdominal op might soon be on the menu of choices for expectant Canadian mothers, it triggered a fiery debate. As it turns out, the Society of Obstetricians and Gynecologists of Canada (SOGC), which had supposedly arrived at the controversial conclusion, is still studying the issue and has promised to rule on it by early summer. It seems more and more women are requesting C-sections for personal, non-medical reasons, and so far no one is stopping them. Now the question is, is this all just another expression of our collective obsession with quickie-mart convenience, control and scheduling, or is this a bizarre but legit twist on "women's right to chose"?
To date, one in five births in Canada and nearly one in four in Toronto is a Caesarian. Most are performed for medical reasons: in problematic or prolonged births or when babies are in the breech (feet or butt first) position, doctors generally insist on or strongly advise ditching the old-fashioned route and prepping for surgery. But what of those women who chose to go under the knife? Why willingly reject what some say is the greatest opportunity women have to embrace the raw grandeur of nature?
"The classic example," says Vyta Senikas, SOGC's acting executive director, "is the infertility patient, a professional. It's taken her so many years to get pregnant, and this may be her only shot. She wants a C-section because she wants absolutely nothing to go wrong."
What they don't appreciate, explains Senikas, is that having a C-section doesn't guarantee a clean bill of health. In fact, the operation is associated with higher maternal mortality rates and greater blood loss and risk of infection, not to mention the four to six weeks recovery time.
But some women are willing to swallow the risks to themselves for what they presume are lower risks to their babies, who are spared the potentially "dangerous" passage through the birth canal. As Dr. Mary Hannah, director of U of T's Maternal Infant and Reproductive Health Research Unit, says, "I think there's enough evidence to support elective Caesarian section to (give women) the opportunity to chose." And last year, the American College of Obstetricians and Gynecologists agreed.
But even doctors admit that not all women have the baby in mind when they ask for section. A certain segment want to schedule delivery like any other appointment in their life.
Marni Jackson, author of The Mother Zone, says it's all part of an attempt by working mothers to retain control of their lives. "The busy woman makes an appointment and is therefore not at the mercy of nature, her body or her baby." Adds Jackson, "In their struggle to control other areas of their lives, women fear that they're going to lose their identity. But getting a C-section is only giving them the illusion of controlling this whole process." What kind of control can you really have when you cordon off your head behind a curtain and allow doctors to turn birth into a surgical process? Plus the illusion, she says, goes up in smoke the moment you and your baby are sent packing from the hospital two days later.
Others see C-sections as the best way to get around the sheer pain of delivery. Another manifestation, says Jackson, of our "magic-pill dream that we can really vanquish pain." But a few mothers may have a legit psychological excuse, says Gail Erlick Robinson, head of the Toronto General Hospital's Women's Mental Health Network. "Some women for various reasons - past sexual abuse, body fears or past bad deliveries - have specific fears and anxieties about childbirth. In some of those cases a C-section might be warranted, but I don't think the majority of women have powerful enough fears (to elect to have a C-section)."
Still others, pining for the fountain of youth and that yummy-mummy image, might be more fearful of stretched tummies and vaginas, says Robinson. This is especially true now that C-sections leave only discreet bikini-line scars. Hollywood isn't helping much when celebrity moms like Madonna, Gwyneth Paltrow and Liz Hurley, leading the "designer" delivery brigade, magically appear in public six weeks after giving birth with bellies flat, babies in tow, youthful bodies intact. Could C-sections be their secret?
While the actual percentage of women choosing C-sections is small (around 2 per cent of births in the U.S.), it is rising. Though most doctors would say the overall C-section rate has been climbing for medically sanctioned reasons, physicians may have propelled rates for reasons of their own, like fear of litigation. (Failure to perform C-sections early enough to save a distressed baby can bring on big lawsuits.) And as one nurse said, "Who wants a disturbed night's sleep if you can do that section before you go to bed?"
It's the kind of reasoning that pushed the World Health Organization to declare all rates above 15 per cent to be superfluous. The org even called for a rollback in international rates to meet that target by the year 2000, but few countries seem to be listening.
Take Brazil, for example, where section rates in private hospitals are anywhere from 55 to a jaw-dropping 98 per cent. While public hospitals are now punished for going above the 15 per cent target, upper-class clinics still cater to the perception that Caesarians are a symbol of status and modernity. Natural birth is deemed too "primitive" for the "too posh to push movement." Plus, one Brazilian surgeon told the press he could do a dozen Caesarians in the time it took to supervise one natural birth.
Which brings us to the question of cash. Here in Ontario, OHIP pays hospitals twice as much for simple C-sections as for standard births. That includes the added cost of an anaesthetist, an assistant and longer hospital recovery-room time for the mother.
"There's a resource implication," says Ryerson's associate dean of nursing, Edith Hallan. "If you use up all your money delivering women by Caesarian, then you're taking away money that could be used to give women choices in other areas."
Midwives agree and are trying to steer labour trends in quite the opposite direction. Kristy Hook, vice-president of the Association of Ontario Midwives, says women who opt for C-sections are missing out on experiencing "one the most empowering things women can go through."
And, adds Hook, "As a culture, we have to think about what we do to ourselves when we turn a normal physiological event that's been part of the lives and history of women forever into something that's controlled, scheduled and medicalized."