'Just knock me out at the first twinge, then wake me up in thehairdressers,' was the comedian Joan Rivers' idea of the ultimatepain- free labour. It was, of course, a witty one-liner, but also apertinent statement about women's increasing demand forintervention. Natural birth remains the choice of a small minorityof women, who take on non- medicalised childbirth often as a crusadeand are therefore viewed suspiciously by many midwives andobstetricians.
There has been a marked rise in Caesarean sections in the UK inrecent years. In 1970 Caesarean sections in England and Walesaccounted for less than 3 per cent of births. Just three years ago,an Audit Commission report stated that 11-18 per cent of babies weredelivered by that method. Now, that number has risen to 30 per centin certain hospitals, even though the World Health Organisation saysthat there is no justification for a Caesarean rate of over 10-15per cent.
The seemingly unstoppable rise in the UK section rate is part ofa growing movement created by doctors and patients in pursuit of theeasy birth. Reports out this week of a new drug currently beingdeveloped by the company Ardana Bioscience are all part of thistrend. The drug works by 'ripening' the cervix and making it moreelastic, so that a baby is born more easily. It is meant to makelabour quicker, safer and less painful by reducing the length offirst-time labours, which can be as long as 18 hours.
Beverley Beech, honorary chairman of the Association ofImprovements in Maternity Services, is not impressed. 'I felt a coldshudder when I read about the drug,' she says. 'Why do women wantlabour sped up? It's obstetricians who want it and kid women thatit's a good thing. To talk of an 18-hour labour is misleading; womenthink it means 18 hours of pain, when in fact they're slowly workingup to a crescendo. How many shocked, distressed babies are we goingto get out of this?'
In Beech's view, the increasing medicalisation of labour is acost-cutting exercise in the NHS. The intention, she believes, is touse fewer staff, free up hospital beds and get women out of hospitalsooner.
'The risks of a section are horrendous,' Beech says. 'It lowersfertility and creates post-op complications, as well as increasingthe risk of problems in the next birth. Also, studies have shownthat women are less satisfied with the birth and less likely tobreast-feed as a result. You are also five times more likely to diefrom a Caesarean section than from a normal vaginal birth.'
Julia Cooper, 28, gave birth to her first child this year. Shehad planned a home birth until, at 36 weeks, she was told the babywas too big and there was a chance of shoulder dystocia. When sheasked her obstetrician for more information so as to be able to makean informed decision, a midwife was summoned, who told her thatshe'd been present at two shoulder dystocia births, one of which hadbeen fatal.
Unconvinced by that anecdotal evidence, Julia asked to continuewith her home-birth plan, but the midwives refused to support it. 'Iwas told I had to have a Caesarean, that Caesareans were safe andgetting safer all the time. They said in a few years' time everyonewould be having them. What could I do but consent? But,unfortunately, there were complications, and they illegallyhysterectomised me. I had told them not to, but they did without myconsent.'
Julia is suing the hospital. Worst of all, she has been told byfive separate experts that on medical grounds the operation wasunnecessary. The experience has shattered not only her faith in themedical profession but also her dream of having a big family. She isnow exploring the option of surrogacy but feels extremely bitter athaving to resort to such expensive and distressing methods. 'It'sbeen a horrendous year,' she says, 'and I'm now convinced thatobstetricians are just scalpel-happy.'
With obstetricians taking a lot of flak for the rising Caesareanrate, one excuse they often give is that women are demanding it.According to Professor Edith Hillan, from the department of nursingand midwifery at Glasgow University, women such as Victoria Beckham,Patsy Kensit and Madonna have set the trend by having electiveCaesareans. 'Women are increasingly reluctant to have a great longlabour,' she says. 'Of course, a section isn't always for the wrongreason and is often life-saving, but we need to be asking why aquarter of women suddenly want them when the procedure comes with arisk that wouldn't be associated with vaginal delivery.'
Yvonne Williams of the Caesarean Support Network puts it down toignorance. 'The vast majority of women are not educated aboutchildbirth. A hundred years ago, it was different, when women weredelivering one another's babies at home. Now, they think they canjump off the operating table and walk. Some women who ring me thinkthat by having a section they're doing away with pain and risk, butI have to point out that it's major surgery they're having.'
Williams has only praise for Cherie Blair. 'A lot of us wereexpecting her to have a Caesarean, but instead she went the naturalway and did a lot of good by showing women that they shouldn't befrightened of labour.'
Belinda Allen decided to go the natural way when she had herfirst child. 'I went to antenatal yoga classes in Notting Hill, runby a woman whom everyone considered the guru of natural birth. Shetold me birth would be a deep and enriching experience, advising usto `moan like a cow'. Later, I also went to see Christine Hill, whowas much more down-to-earth and talked about your vagina being thesize of the Grand Canyon. She told it like it was. I actually thinkmaking you feel guilty for not having a natural birth does a hell ofa lot of harm, because it plays on women's terror.'
Belinda's planned natural birth came to nothing because the babywas two weeks overdue and finally had to be induced. A long, painfullabour followed, resulting in an emergency Caesarean after 24 hours.'You couldn't get a more sterile, sanitised birth than mine, nor amore painful one. I had every single kind of pain relief and medicalintervention you can imagine.'
Even so, despite the relief of having the doctors intervene, shewishes they had either opted for a Caesarean (instead of goingthrough hours of failed attempts to get the baby out with forcepsand Ventouse) or simply waited to let nature take its course. 'Ican't help wondering, if they hadn't induced me with Syntocinon,which speeds up contractions, and if they hadn't given me anepidural, which slows down labour, then perhaps the whole thingwould have been far less traumatic. After all, on the day of beinginduced, my waters broke naturally, so perhaps the baby would havecome out on its own if they hadn't started sticking tubes in me.'
Beverley Beech points to Belinda as one of a growing number ofwomen who are told there's no point going into labour, becausethey're likely to have a Caesarean anyway. Having had one section,Belinda went on to have two more because, as she says: 'They told meI had a 25 per cent chance of getting out the babies naturally,because of the shape of my pelvis, and I couldn't face the thoughtof trying and failing.'
Some time ago, a woman I know sent me the following account: 'Onthe day of the birth, my lover filled the room with pink and redroses and church candles. I received two messages from friends, withoils of jasmine and rose, recommended to prepare women for labour. Ialso had acupuncture to tune my body to its maximum birthingcapacity. As the midwife massaged me, the labour began, and wefilled the birthing pool with water. When the pain became moreintense, I slipped into the water and allowed it to support andsoothe my body. Four hours later a beautiful little girl was born.The energy in the room was wild.'
Such scenes do not occur in labour wards or hospital operatingtheatres, and although many strive for that kind of experience, manymore share Joan Rivers' desire to be as comatose and removed fromthe barbaric act as humanly possible.
