I just had to respond to an article in the West today.
In the article Dr Gannon stated that if we aim to decrease the c/section rate in Perth we will increase forceps deliveries.
I would love the chance to chat with Dr Gannon about the physiology of labour and birth and to have a discussion around the growing literature of what actually lowers c/section rates.
In the interest of fairness I do have to agree with Dr Gannon on one point.
He is right that the c/section rates have been “stable” in WA, although that is an interesting choice of word.
It may be “stable” but it is certainly not “just about right”.
According to WHO guidelines 34% is a long way from “right”.
“Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10%, there is no evidence that mortality rates improve”.
The private hospital Dr Gannon works at has a rate of 45.6% according to the latest statistics.
(I have summarised the latest reported rates for Perth HERE )
I really have a problem with Dr Gannon once again blaming older, larger mums for the c/section rise and I would love to see what evidence he is referring to about smaller families, but that is a blog for another time.
I am also not going to go over the short term and long term risks of c/section for mums and babies which Dr Gannon always glosses over.
My main problem with this article is the apparent assumption that it is either c/section or forceps.
Forceps are not the answer to lowering the c/section rate.
Here are some things that research has shown that lower c/section rates:
1. Giving women more time in labour especially second stage.
A 2016 study found that c/section rates dropped by 55% when women were given more time than the current guidelines which were proposed in the 1800s (face palm).
2. Saying active labour begins at 6cm not 4cm.
4cm is based on a 1950’s study of around 100 women, whereas 6cm is based on a 2010 study of 228,668 women.
Most Perth obstetricians and hospitals still use 4cm.
3. Labour starting spontaneously.
OBs like to say that induction of labour lowers c/section rates but the latest research says otherwise.
This 2016 Swedish study of 1,078,536 women between 1999 and 2012 concluded that induction of labour had substantially increased during the 14-year study period and was associated with an increased risk of caesarean delivery.
A 2017 Australian study of 44,698 women between 2007 and 2013 found that induction of labour increased the risk of emergency caesarean for fetal distress.
A 2107 US report of 2851 first time mums between 2009 and 2011 found that women who were induced were more likely to have c/sections.
So the evidence is stacking up that induction of labour, especially with your first baby, leads to a higher chance of caesarean section.
4. Continuous support during labour and birth.
The 2017 Cochrane Review found that continuous support during labour and birth by a midwife or nurse, a doula, or support person lowered c/section rates and had other great benefits.
“Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. “
But the support wasn’t clinical support.
It was emotional support (continuous presence, reassurance and praise), information about labour progress, advice about coping techniques, comfort measures (comforting touch, massage, warm baths/showers, encouraging mobility, promoting adequate fluid intake and output) and really importantly speaking up when needed on behalf of the woman.
In contrast, the Review found that the lack of continuous support during childbirth “led to concerns that the experience of labour and birth may have become dehumanised.”
5. Childbirth education that includes complementary therapies.
A 2016 Australian study found that incorporating evidence based approaches such as acupressure, visualisation and relaxation, breathing, massage, positions, and partner support lowered c/section rate by 44%.
Standard hospital based classes that really just talk about hospital policies and protocols just aren’t good enough.
Pregnant couples need to look for alternatives such as a Hypnobirthing Australia™ Course.
The article also raises the issue of birth trauma
There is no denying that forceps can leave women with psychological and physical trauma, but so can a c/section or a vaginal examination without consent.
Or simply feeling like you are not part of the decision making process.
Or “dehumanising” birth.
In fact, whatever the birth, whether a woman or her partner feel traumatise or suffer from PTSD after it will usually come down to how respected they felt during the birth.
Something some Obstetricians just don’t seem to understand.