Caesarean rates follow-up

My friend Robin is very involved in birth advocacy, particularly in educating women (and the health system!) about the advantages of vaginal birth for breech babies. I admit it sounded a bit wild to me when I first heard about it, but when you actually look into it, it turns out that, for certain breech babies, the risks of vaginal delivery are no higher than C-section deliveries. (You can find out more about this at the Coalition for Breech Birth website: www.breechbirth.ca.)

Anyway, I am bringing Robin in here because The Ottawa Citizen ran a story very similar to the CBC story I posted earlier, and she wrote an excellent letter to the editor about the risks of having a high C-section rate. You can read her letter without having read the related Citizen article, but if you're interested in it, here's a link.

Good afternoon!

I was delighted to read your article this afternoon regarding concern over the rise in caesarean rates.

I am one of the co-founders of the Coalition for Breech Birth, an Ottawa-based grassroots coalition working for the re-normalization of breech birth.

I admit that I was shocked to read that Andre Lalonde suggested "there has been a recent push to encourage women with breech babies to deliver vaginally." It is nearly impossible to achieve a vaginal breech birth in Ottawa, especially in the hospital (homebirth with a midwife is an option most women are not aware of). Just this past Monday, a woman who contacted us was forced to fight tooth and nail to achieve a vaginal breech birth at the Civic. She was lectured, coerced, and threatened by the doctors, residents, and nurses, and told (incorrectly, according to the published evidence) that she was endangering her baby. How is this "encouraging" a woman to birth vaginally? It's not even "supporting" an intelligent woman who has already done her research and has made an informed decision about the best birthing mode for her baby. In addition, unless there has been a very recent change, the guidelines of the Society of Obstetricians and Gynaecologists of Canada still state that the standard of care for breech birth is Caesarean surgery, and most obstetricians fear professional censure should they openly offer options that go against their organization's recommendations.

I was also astonished and disturbed to read your quote by Dr. Walker: "Is a 25-per-cent C-section rate a bad thing? I don't think there's the data out there to qualify that it's bad ... What we want is healthy mothers and babies. That's the outcome we want." While it cannot be argued that "healthy mothers and babies" is the basic goal of childbirth, this is the most basic of goals, and "healthy" is a subjective term. A mother who experiences surgical birth unnecessarily walks into the hospital healthy, and leaves the hospital permanently injured, with a uterine scar that makes many obstetricians recommend that she not attempt vaginal birth in the future.

The long term physical and emotional ramifications of surgical birth go far beyond the limited 6 week follow up period for which obstetricians typically follow women. Every surgical birth a woman experiences increases the liklihood of another surgical birth; and with every subsequent surgical birth, the risks grow higher for the mother. Ultimately the number of babies a woman can carry is limited by surgery; a woman who has had 3 surgical births is generally told not to have more children, because her uterine strength has been compromised by the repeated surgeries. Peer-reviewed evidence shows that women who experience surgical birth are more likely to suffer from post partum depression, experience difficulty bonding with their babies, are much more likely to have difficulty breastfeeding, develop painful or even debilitating scar-tissue adhesions, experience bowel or bladder incontinence, have varying degrees of permanent nerve damage, and are three times more likely to die in childbirth. The World Health Organization has stated that no developed nation should have a caesarean rate of over 15%. This means that nearly half of the surgical births in Canada are not needed, at great detriment to the families trying to adjust to a new baby and recover from major surgery simultaneously. What data Dr. Walker is still waiting for is very unclear.

As a woman who experienced both an unmedicated vaginal birth, and surgical birth for no medical indication other than encountering an obstetrician on call who was not qualified to catch a breech baby, I can attest that a "normal" recovery from this surgery, and the recovery from normal vaginal birth, are worlds apart. Mothers are often very traumatized by surgical birth, especially if they have done their homework and know, or even suspect, that the surgery was not needed. Doctors who treat surgical birth as "equal to or better than" vaginal birth demonstrate that they are exceptionally short-sighted and out of touch with the needs of birthing families. There is far more to having a baby than the simple extraction of the child. Treating birth as a pathology that needs to be cured, and that has no merits of its own, is a fundamental disrespect of a natural and safe process of the female body, and demonstrates a paternalistic and condescending attitude towards the woman and her family. The complete, accurate information, and the choices, belong in the hands of the people who live with the consequences of the birth.

I invite you to visit our website and read our stories, as well as the peer-reviewed research presented on the Articles page regarding the safety of vaginal breech birth. I would be delighted to discuss the issue further, and would be deeply grateful for any exposure you can give to this issue.

Best regards,
Robin Guy
613 820 7995
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Coalition for Breech Birth: www.breechbirth.ca.
Please visit and consider signing our petition to have the SOGC change its breech birth guidelines.

"Refusing vaginal breech birth is a human rights violation in that it forces women to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no access to informed refusal." - Henci Goer, author of "The Thinking Woman's Guide to a Better Birth"