Don’t cut the baby out!

The Problems with Surgical Birth.

Stop cutting the baby out; Surgical birth.

In December 2017 in the city of Ipswich a family doctor with no specialist qualification in Obstetrics attempted to deliver a baby to a heathy mother in a bath tub in the mother’s house  

In the horrific events that unfolded the mother began to bleed to death filling the bath tub with blood and the doctor attending her, attempted to resuscitate her sitting up in the bath.

The shocked paramedics who attended the scene were astonished that someone would attempt cardio-pulmonary resuscitation on a patient sitting in a bath. The doctor obviously appalled at what was happening declined to tell the attending paramedics that she was a doctor. No amount of transfusion would save the mother who died in hospital.

These days a death of a mother giving birth is incredibly rare, as little as one in 20 thousand.

This mother, desperate to avoid hospital and the possibility of medical interference in a natural process of birth placed herself in the hands of a person devoid of obstetrical skill.

Ironically this demonstration of a complete lack or basic birthing skills in this doctor, which led eventually to her being charged with attempted murder, came after 200 years of extraordinary success in the field of obstetrics.

It come as the result of the cesarean section, the surgical birth, the last resort in obstetrical care, displacing completely the host of non-surgical birthing techniques which normally would obviate it, make it unnecessary. What follows is the explanation of how this has happened.

The boon of safe surgical removal of a live infant in a complicated pregnancy when all other options failed, help to revolutionize obstetric practice. No one realized that the Cesarean section, would become a curse and eventually the most common method of delivery.

The operation, Cesarean Section, named for the Roman General and would be Emperor is the only medical procedure to be styled after a great historical figure.

The reasons for this remain obscure because the general himself could not have been born by this procedure as his mother was his living contemporary. No woman in ancient times would have survived such an operation.

It is thought that the term referred to a law that provided a sanction for removing a baby by operation from a dying mother.

In modern times this have been reversed as the mother is always sustained at the expense of the baby and maternal death from birth had become vanishingly low in modern times, but, as this article will illustrate, it is rising again.

It was well over a thousand years after the death of Cesar before the first successful operative birth occurred, allegedly carried out by a sow Gelder, Jacob Nufer in Switzerland on his wife.

She not only survived but had five more children. You may ask what a sow Gelder is. It is a person who castrates pigs. This remarkable event, like most things in history, is disputed.

As we would expect, the Americans claimed to have perfected the operation first and the man responsible was the surgeon Jesse Bennet in 1794.

As the twentieth century progressed the developments in natural childbirth were dramatic. Not only did doctors perfect the use of forceps and other instruments such as the Ventoux vacuum device, but break throughs in drug use including epidural anesthesia, birth induction remedies, specialized scans and fetal monitoring, made childbirth safe and virtually painless.

Nevertheless, mostly women still preferred to push their children out under their own steam as a natural process.

The incidence of maternal fatality in childbirth became so low as to be almost unheard of. The “revolution” in safe obstetrics had arrived.

Waiting at the very end of the long line of alternatives to natural birth was the surgical procedure, Cesarean section, the last resort so much so that obstetricians felt that they had failed their patients if they had to have surgical birth.

Women wanted to have their babies naturally, to be there to hold their child when it was born, to breast feed as soon as they were able. Modern obstetrics made all of this possible.

This changed in the 1960s and suddenly the horror of having to have an operation to give birth became closer and closer to the norm.

The rate of surgical births dramatically increased from a low of 5 – 10% to 35 to 40% in public clinics and over 60% in some private clinics.  

In many countries around the world, Brazil, Turkey, Egypt, the incidence of surgical births exceeds that of vaginal births.

In these less developed countries the high rate of cesarean procedure is the result of the fact that skilled obstetricians are very rare and women do not have access to modern obstetrics so surgery is almost the only option in the event of complications.

The drive to eliminate natural birth and replace it with surgery already has terrible consequences and these are expected to become even worse.

However, it is in the nature of human beings when some drastic and unacceptable development occurs for which they are responsible, to reverse the narrative and present it positively. There are many examples of this but in this case, we have the notion of the “gentle Cesar”.

This absurd idea arises because women are encouraged not to feel guilty if they are pressured into surgery and are actively discouraged from insisting that they have a natural birth In other words this is simply another way of putting them off the idea.

The “gentle Ceasar” is so called because an arrangement is made with surgical drapes so that husband and family can continue to communicate with the mother while the child is being removed from the womb but do not have to see the incision, the bleeding and the internal organs.

As the baby is born it is handed to the mother and the family and she interacts with him or her though, of course she is unable to place it on her abdomen.

In reality, however it may be dressed up, the process is no less mentally and physically traumatic than an ordinary cesarean and the recovery time for working, driving and so forth remains at six weeks compared with a vaginal birth when mothers can be working and driving after one or two days, highlighting the first major downside with surgical birth.

The ”gentle Cesar” while sounding good in practice is often not achievable. It requires a spinal or epidural anesthetic by a skilled anesthetists.

Skilled anesthetists are not required for normal births but they are required in every case of surgical birth, greatly raising the costs, taking them away from routine operations and greatly extending the waiting times for routine surgery across the nation.

These doctors use their considerable skill to anaesthetize the body below the waist so that these “gentle Cesars” can take place. In a significant number of cases, as has been my own experience, that this form of anesthetic fails, in as much a 20% of cases .  

Too often these mothers are told that their “gentle Cesar” is going to require a general anesthetic after all.

The enormous growth of surgical births as greatly increased costs and reduced the availability of operating theatres and staff. As time goes this situration is getting worse and because surgical births can only happen in cities, rural areas suffer.

A nurse midwife can deliver a baby in the bush and rural areas but surgical births force mothers to travel many miles to have their babies and often have to live away from their families if the procedure is scheduled because of foreseen medical complications.

This has led to unacceptable deaths of babies, babies being born by the road side and in one of the most tragic or all, a near-term mother travelling around in a capital city in an ambulance waiting for a hospital to accept which led to her death and the death of the baby.

Many obstetricians, once skilled doctors who could deliver babies using instruments like forceps have now abandoned these practices and simply Cesar every mother with any complications no matter how trivial.

Some national centers with populations of over 70,000 persons have lost these specialists altogether.  Gladstone is one such place and despite every effort by Government, a proper birthing service led by a qualified specialist obstetrician no longer exists.

While midwives have the basic skills to deliver babies, if a skilled obstetric surgeon is not there and readily available to back them up, they cannot do the ordinary work of natural delivery.

The need to have skilled specialists managing pregnancy has grown whilst at the same time that their numbers are in decline. Mothers are getting older and more and more women with diabetes and excessive weight are having children.

These complications are more likely to lead to an increase in the number of surgical births, It is hard to see that these trends can be reversed.

Many researchers have drawn attention to less well-known complications of surgical birth. Michael Mosley, now deceased, was one such and he often presented evidence from careful studies  which showed that children born by Caesar missed out on important exposure to bacteria and antibodies in the mother's birth canal when born into the maternal secretions.

Later in life the loss of these vital ingredients increased the risk of allergies and autoimmune illnesses in children born by surgical birth. Medical science is only now discovering all the disadvantages a child born by Ceasar has compared to a child born naturally.

I have attempted to cover just some of the problems, long term and short term, associated with surgical birth, including the blowing out of surgical waiting lists for routine surgery, the loss of skills by obstetricians, the decline in health services in rural and country areas, the risk of death of both mother and child, the prolonged maternal recovery time and the long term consequences for children.

Yet there are other problems, the financial cost to patients society and the adverse emotional effects on mothers who do not bond as well to a child born by surgical birth.

As doctors perfected the wonderful techniques that led to a revolution in maternal and child health care during the 20th Century where Cesarean section was the last resort when all other options had failed, they never would have imagined that this last resort would become the most common form of child birth of all.