Lack Of Experience Doesn’t Equate To Informed Decisions, OBGYN

I read an article titled Why Posh has the right to push: Caesareans are no more dangerous than natural births last night, and I have been hopping mad  over it ever since.

Let’s be clear about a few things here:

1. I don’t care what Posh (Victoria Beckham) does. My anger isn’t about her.
2. This is an article in the Daily Mail. It’s not journalistic excellence, but is the kind of thing the majority of the country reads on a daily basis.
3. I am not bashing women who’ve had emergency caesareans here -or even less the ones that have had elective caesareans – your body, your choice.

But Clive Spence-Jones, the Consultant Obstetrician and Gynaecologist who wrote the piece has my blood boiling.

He says Every woman has a right to decide how they give birth, whatever the method. Wow. What a load of rubbish. It’s amazing to me how easy it is to say that when you’re pro the medical model of birth, but you walk through a mother’s group on any day of the week and ask the mothers about their births and you will find very, very few who had the births they hoped for.  Once you walk into a hospital, you’re on their schedule and your ‘right to choose’ anything around your birth gets a whole lot smaller (Just this weekend a friend of mine gave birth  she was told she had to go on the hormone drip and when she said she’d like to wait an hour, she was lectured for 15 minutes on why she has to do it. That’s not choice! She eventually agreed to get the woman to shut up.)

He says of experts warning that multiple caesareans are putting lives at risk, This scaremongering is outrageous, misleading and does nothing to help women become better informed about the realities of delivering a baby.

Well, let me interrupt myself here to say this: Would you get breastfeeding advice from a formula company? Would you take dieting advice from an obese person? A baby food manufacturer about when to start weaning? So why would you listen to a Consultant Obstetrician and Gynaecologist about anything to do with being ‘better informed’ about the ‘realities’ of delivering a baby.

To start with, it’s in his interest to keep caesareans popular.  This is a profession with a starting salary of between £74,504 and £100,446 per year – as compared to the £20,710 starting salary of an NHS midwife (a consultant midwife’s salary can start at £37,996, although midwife consultants can occasionally receive as much as £79,031 at Band 8D – the higher end of management scales).

Don’t be fooled into thinking he has your best interest in mind.

The expert he is referring to is Makrina Savvidou, also a consultant obstetrician who works on the private maternity ward of the Chelsea and Westminster hospital, who recently warned in an article for The London Evening Standard that Women like Victoria Beckham who have multiple c-sections run the risk of a medical emergency.

While I could start quoting studies here about the risks of repeat c-sections, the fact of the matter is that for every study I quote you could provide a counter study, and that’s self defeating, as I said this isn’t really about c-sections. It’s about the rest of his article.

• For example, about one in three women who have a natural birth will suffer from bladder problems because their pelvic floor muscles are weakened.
  While that is true, it is not something that can’t be fixed. If more women were taught how to exercise their pelvic floor from a young age rather than something you start doing at 30-something weeks pregnant, for example. He also doesn’t mention the link between episiotomies and epidurals – more man made interventions – and pelvic floor weakness.  I guess it depends on your description of  ‘natural birth’ but I’d love to see a study that shows how many women who had zero interventions suffer from bladder and pelvic floor problems?
• The vast majority of women who opt first time for a caesarean section do so for medical reasons. The baby could be in the wrong position or become distressed during labour.
  This was the real kicker for me, and just reading it again now,  I can feel my anger rising. The baby could be in the wrong position. Now, giving him the benefit of the doubt, maybe he means transverse. I’ve not personally heard of any transverse natural births. I know my daughter was transverse at one point, and we did everything in our power to turn her, which she eventually did.But, the problem is, he’s not talking about transverse babies only ‘he’s also talking about breech and back to back babies. I KNOW people who’ve ‘had to’ have c-sections because of back to back babies.  Mothers who have a stubborn c section shelf can get it treated. I’ve lost count of how many I’ve met who ‘had to’ have a c-section due to a breech baby. (Despite studies that have shown breech vaginal deliveries to be as safe as or safer than c-sections) And here’s my problem with his statement: You can’t on one hand say women should have the right to choose after informed decisions when your INCOMPETENCE is what’s informing their decisions. Most medical staff these days do not know how to handle a breech birth.  As Professor Glezermann (the study Iinked to just above) says of breech deliveries “The skill has disappeared,” he explains. “Residents are no longer taught these techniques, and senior physicians are doing it less and less. We need to go back to the future and relearn what has been forgotten.” (He also runs workshops to teach OBGYN’s how to deliver breech babies.)I’m sorry, Clive Spence-Jones, but lack of experience doesn’t equate to informed decision. You are failing mothers.
• But you can’t just define cost in terms of pounds and pence. It is also about the cost of damage to a mother’s emotional well-being from a bad birth experience or to the health of her child resulting from a traumatic delivery. For example, about ten per cent of cerebral palsy cases are the result of physician errors during a natural deliveryWell. Thank you for kind of making my point.It’s easier for YOU if we have a c-section, because there’s less chance of us suing you for you not being able to do your job properly. Ms Savvidou, in her London Evening Standard interview, says “It’s an uncomfortable truth that the area of obstetrics has a high incidence of litigation compared with other medical specialities. I’m certain this has contributed to the rise in numbers of c-sections – in previous years obstetricians would possibly try to encourage vaginal births but more recently requests for c-section have been accepted on less medical grounds as this procedure as a form of delivery is predictable and safe in most cases, despite it being a surgical procedure with it’s own inherent risk.”Thinking of a friend who had her baby recently. She was contracting well, but each time the doctor stormed into her room, her contractions stopped. The same doctor who kept yelling at her to push, until the midwives told him the contraction was over. Yet, she pushed, because she was desperate to avoid a c-section.

  If a woman has a bad birth experience, doctor, because you didn’t know what you were doing you have failed her. And medical malpractice is a very serious case.

  We don’t allow a fireman to come  into our  house and throw us over his shoulder and drag us down the stairs, in case there might be a fire because we have a gas oven. We don’t allow a policeman to arrest a grubby looking person because he might commit a crime. We don’t allow a doctor to amputate a leg because the infected toe might become gangrenous. Why should an OBGYN get away with surgery because there might be a complication when he is doing his job?

• No one likes a drama or a terrible outcome. And that is why childbirth should be about the safest outcome for mother and baby, as well as the staff involved.You know, when I go for a massage, my concern isn’t with the health of the therapist. I trust that she’s learned to do her job, that she knows when to take breaks, that she’s taken the correct health and safety steps to ensure she doesn’t injure herself, and that she has he training not to injure me. Why should an OBGYN have any different treatment? The safest outcome for mother and baby IS the most important, I agree, but again, doctor, if YOU don’t know how to do your job properly, take up something else and leave it to the midwives.YOUR lack of training, experience and willingness to give the flexibility, time and patience that natural birth requires does not give mothers choice. It gives them lack of options.

Image Credits:
Informed Consent from CCHRI

Breech Birth from CMT eJournal

Litigation from APIL