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I have been reading about methods of delivery (or birth as I would prefer to call it) in Scotland 2020/21 especially as it covered the period when we were mostly in lockdown due to Covid. It seems like despite the other aspects of our lives being thrown into disarray during the pandemic, and the massive influence it had on so many aspects of maternity care, the actual way we birthed our babies did not significantly change.
However, during 2020-March 2021, Scotland recorded the lowest amount of 'normal vaginal deliveries' since records began in 1975/76. with a total of 51.6% babies born by spontaneous vaginal birth. Meanwhile, the proportion of births by caesarean rose and is now at its highest at 36.1%.
Are you planning a caesarean birth or do you want to learn more about what happens during a caesarean? During the Complete Birth Preparation Package we cover what happens during a caesarean, how you can make it special for you and how to recover postnatally.
There are many reasons why people believe the caesarean rate is rising: increased maternal age, increased maternal BMI, maternal request, previous caesarean birth and the threat of litigation. ‘Word on the street’ would also suggest the rise in induction of labour too, though that is a can of worms. I was particularly interested in this however which I read in another report shortly after seeing those stats:
"The view of obstetricians and midwives, and the role they play in influencing decision making around caesarean sections is important in helping to understand the variance in caesarean section rates. Studies which aim to offer insight into obstetricians' and midwives' views on caesarean sections and the factors that influence the decision mainly follow on the clinicians' personal beliefs, perceptions of risk and safety and clinician characteristics."
https://www.gov.scot/publications/best-start-review-caesarean-section-rates-scotland/pages/6/
https://publichealthscotland.scot/publications/births-in-scottish-hospitals/births-in-scottish-hospitals-year-ending-31-march-2021/
When we enter the world of hospital, that world has guidelines, procedures and protocols which the staff follow. These can often vary from hospital to hospital and health board to health board, already suggesting that there is not a standardised approach to care.
Midwives and doctors are human too with all the messy qualities that go into making us wonderful and unique and I find it hard to see how they cannot let their lived experience, and the previous births they have witnessed, influence their medical practice (even subconsciously) and also their perception of risk.
I have worked with anaesthetists antenatally who freely admit that they entire view of labour and birth is completely skew-whiff because they only ever see birth when mum is not coping or needs medical care in theatre. They never get to see the calm mum who is rockin' it in a birth pool.
I have heard from parents that they often receive differing opinions on birth and feeding their baby when speaking to different medical professionals. One doctor says something cannot be done where as their colleague says it can. One midwife said my baby's latch was great and another said it wasn't.
I had experience of this very recently was when I went to have a dodgy looking mole investigated on my foot. The doctor said he was 98% certain it wasn't sinister but he wanted to remove it because he had seen a patient a few months previous with a very similar medical history to mine and he had told her he thought her moles were fine and they turned out not to be. He was erring on the side of caution with me.
His previous experience was now playing a part in influencing his clinical decision, but at least he was honest, made me aware of that and left the final decision to remove the mole to me. I had it removed and it turned out to be fine. If he had just told me he was 98% certain it was okay though and hadn't told me about the previous woman, perhaps the mole would still be on my foot.
It is confusing for parents-to-be stepping into this world during antenatal appointments and during labour when they are often feeling vulnerable and scared. During the antenatal class I was facilitating last night, we were talking about birth plans and are they really worth it (that's a blog topic right there). The parents decided that the most important thing was to be aware of their options and to able to have honest conversations with hospital staff about their preferences and expectations. They also concluded they needed to be mindful of how hospital protocols and medical opinion can differ.
Promoting informed choice and decision making is at the heart of my antenatal teaching.
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