Recently I read an article in The Daily Mail about an 'amazing new' procedure that researchers said could revolutionise the world of cesarean sections. As someone who has been in the field of gynaecology and obstetrics for many years, I am always interested in progressive research and welcome anything that can make women's pregnancy and birthing experience as positive, safe and enjoyable as possible. However, as I read on, I was surprised to see that their method was nothing new at all. In fact, it could even be described as dangerous.
In the article, the researchers described a 'natural' cesarean section, designed to mimic to some degree a natural vaginal delivery by allowing the baby time to extract itself partly from the womb before any medical assistance is given. This allows the baby time to acclimatize its lungs to the air outside its mother's body, reducing stress. Then, as soon as it has been born, it is given to its mother immediately to enable them to bond as soon as possible.
According to the article, the trials have been successful so far and further research has been commissioned so that, in the future, they hope to make this procedure available to all women. However, as gynaecologists, we have been delivering babies by C-section for many years (dating back to the Roman Empire!) and I, along with many other gynaecologists, have always believed in giving the baby to the mother for skin-to-skin contact immediately after birth, when possible, whether after a vaginal delivery or C-section. This is nothing new and leads me to question why vital financial funding has been given to these researchers when there are so many other areas in fertility and antenatal care that would benefit from funded research so much more.
Secondly, I also question the safety of the procedure. C-sections are, no doubt, an amazing and very important procedure. They are also very popular; with statistics showing that the number of women opting for a C-section delivery over a vaginal delivery has more than doubled since the 1990's - an astounding rise!
I firmly believe that a woman should have the right to choose her birthing method; however, it is important to remember that a C-section is an intricate operative procedure, involving an epidural, spinal or general anesthetic and a large open wound. Moreover, on introduction, its purpose was to reduce the risk on the mother and baby. Therefore, anything other than that, in my opinion, should be carefully debated. For example, delivery by C-section to reduce pain; for convenience; because it will enable the surgeon to spend less time with the woman whilst she's in labour; or because it's profitable for hospitals and health care providers should not be reasons for avoiding a vaginal delivery.
In the case of the 'natural' C-section, it has the potential to be quite dangerous as, allowing the baby time to partially extract itself over a period of approximately 4 minutes means that the surgeon is allowing a large wound, with insecure blood vessels of the cut uterine wall and an open uterus to be exposed for an unnecessarily long period of time and, by doing so, subjecting the mother to an increased risk of infection and bleeding. I am also concerned about the possibility of the post-partum hemorrhage and the development of atonic uterus. That is scary.
Thirdly, when delivering a woman by C-section at full maturity, there are several methods we can use to mature the baby's lungs. For example, if it is a planned C-section, we will ensure that the lung has been matured, either by age of pregnancy naturally or using steroid supplements to assist the process. Alternatively, if it is an emergency C-section or the baby is premature, then we can provide the mother with Dextamethasone (steroids), which will help the baby's lungs to mature in time. With this in mind, there is no reason for these researchers to say that it is necessary to allow the baby time in an exposed wound for their lungs to properly develop.
C-sections are a very valuable procedure and continue to play an important role in gynaencology. However, I have noticed in recent years that celebrities and the media have fuelled a trend that C-sections are the 'trendy' option, with Victoria Beckham, for example, being termed 'too posh to push.' This is highlighted by findings that in some countries the C-section rate has risen to 75%!!
A big problem with this is that, in the future, our surgeons will not be given the opportunity to practice and develop the skills required for normal vaginal delivery, with a thorough understanding of how to maneuver the baby in the best way possible. Over time, such skills could become almost extinct and this must be avoided. Otherwise, we are going to rely on the generations of consultants who are coming to the profession without the training and knowledge of how to deliver difficult cases vaginally; or how to improve upon the instrumentation used in the past to allow even better vaginal delivery; and reduce the operative intervention that has its own complications and increased morbidity and, obviously, mortality.
With this in mind, it leads me to question The Government's recent proposal for the £3000 home birthing allowance. When constructing the proposal, they must have considered the number of women having C-sections compared to those opting for vaginal births. They must also have known that the cost of C-sections is far more expensive and cannot be covered by the £3000 allowance alone. Therefore, either they did not do their research properly - which I'm certain they did! - OR perhaps it is a secret plan to decrease the number of women opting for C-sections, restoring their preference for a natural vaginal delivery in a subtle way that doesn't discourage C-sections or discredit their importance. That does not mean that I agree with The Government's home delivery policy; however, it is very interesting....
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