.Choice is an OK word. Health professionals, the media, the general public - we all use the language of choice now. In fact, we often talk about choice as if it were the only important element in childbirth care. Provided that women have choices, anything goes.
Last February, Good Morning America showed the birth of a child on TV. Its web-site announced it as "a less painful choice: modern medicine gives better options". It went on "Many women are just saying no to the pain, and yes to the pain relievers." The word choice is used in advertisements in order to persuade. Good Morning America was a plug for the technocratic take-over of childbirth. In effect, it sold drugs for pain relief, high-tech medical equipment and the hospitals which use these products, and increased the incomes of obstetric surgeons and anaesthetists.
Caesarean section is presented in the USA as a way of "keeping your vagina honeymoon fresh". In Britain, too, it is promoted by some obstetricians as a method of keeping your vagina fresh and rosebud sweet, and saving your bladder from destruction. The implication is that this is how you can keep young, hold on to love - and keep your man. A woman has only herself to blame if she lets her body sag and her insides fall out. The modern way is to have your face injected with botulism and when it comes to childbirth, keep your perineum and pelvic floor daisy fresh by opting for a Caesarean.
Women are not told about the side-effects. More than 93,000 Caesareans are performed every year in the UK. In some hospitals there is a 25% rate. Many obstetricians are no longer able to turn a breech baby in order to avoid a Caesarean. They have become deskilled. You might think that high Caesarean rates would reduce instrumental deliveries. But no. Forceps and ventouse deliveries are also on the increase.
A study of births to approximately 50,000 women revealed a four-fold rise in the rate of "major life-threatening events" or "near miss maternal mortality", with Caesareans. Complications included massive haemorrhage, severe sepsis and uterine rupture. The researchers omitted examining the incidence of thromboembolism, which is the leading cause of maternal death, because of a difficulty in diagnosis. So the true incidence of risk is underestimated.
We are told that Caesarean section rates are mounting because this is what women want. It is their choice. In reality, less than 10% of women choose Caesareans. Those who do are often scared because of what vaginal birth has become and the way birth is managed, the normalisation of clock-watched labours, active management and the harpooning of women to electronic equipment and intravenous drips.
Choice is not extended equally to home births. No-one is told, "We may not have enough midwives to give you the Caesarean you want." All over the country NHS trusts are sending letters to women who have already booked for home births telling them that they may have to come into hospital when they go into labour because there are not enough midwives.
Yet a meta-analysis of over 24,000 planned home births matched to low risk women in hospital revealed that if a woman plans a home birth she is far less likely to have labour induced, an episiotomy or tear, and an operative delivery, and that babies are in better condition.
In spite of this, it is becoming easier to get a Caesarean section than a home birth.
The power of the technocratic system of childbirth is power over mothers. It is also power over midwives. Only half of all trained midwives are working as midwives. Some leave midwifery because of low pay and difficult working conditions. Many leave because the NHS is bureaucratic and autocratic. A doctor writing about the NHS claims that it is "Britain's last great colony. Precisely like colonists, we have convinced ourselves that we know what is best for the natives." Pregnant patients are perceived as "uncooperative", "awkward defaulters" and "difficult patients" who require special skills of management". Psychology is brought in to control women. A senior psychologist employed in a major London maternity hospital explained in her book that good communication means that "compliance and informed consent can be increased." What about informed refusal? It is vital now that we go beyond simplistic communication skills, go beyond the "management" of childbirth - go beyond choice
We need to focus on the essential skill of midwifery - to keep birth normal.
Sheila's latest book is Birth Your Way: Choosing birth at home or in a birth centre (published by Dorling Kindersley).
To visit Sheila's website .
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