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More and more women are having their babies by cesarean section. Is something wrong, and can midwives fix it?

In Canada, overall cesarean section rates are close to 20 percent. In the United States, they are over 25 per cent. That’s much higher than the World Health Organization’s recommended maximum of 10 to 15 per cent. But aren’t doctors just doing their jobs? Women and their babies would die without the high rate of obstetrical intervention - or so we have been led to believe.

Some c-sections are medically necessary, but it has been estimated that as many as half of those being performed are not. One of the reasons for the rising rate of c-sections may be that many pregnant women, and doctors, think the procedure is safer than it actually is.

In reality, c-sections put mothers at greater risk of death than do vaginal deliveries. A study published in Obstetrics & Gynecology in 2003 found that the risk of death from a c-section is four times greater than from vaginal birth. Other estimates suggest two to four times greater mortality.

Complications can occur in c-sections. These include hemorrhage, infection, and visceral injury. Research also demonstrates a link between c-section and postpartum depression.

How then do we reverse the rising rate of c-sections?

Smart Scandinavians

In countries that have significantly lower rates of c-section than Canada and the US, midwives attend the majority of births. In Sweden, Denmark, Norway, and Finland, a full 70 per cent of births have a midwife as the primary caregiver. Mothers are not the only ones who benefit. These countries also boast a lower rate of stillbirths and infant deaths up to the first week of life than any other European or North American country, according to Marsden Wagner, formerly of the World Health Organization and author of Pursuing the Birth Machine (Ace Graphics, 1994).

In a study from British Columbia, midwives show up again as a positive factor in birth. Reported in the Canadian Medical Association Journal in 2002, this study showed that women who had planned to give birth at home with a registered midwife had significantly lower rates of c-section than did women who gave birth in hospital. The c-section rate of the group of women who had planned home births was a low 6.4 percent (women were transferred to hospital for the procedure), compared to the two hospital groups, 11.9 percent for those attended by midwives in hospital and 18.2 percent for those attended by physicians.

How Midwives Make a Difference

When women feel safe and respected, when they are informed about their choices, when they are emotionally prepared for birth and supported throughout pregnancy and labour, they are likely to have confidence in vaginal delivery and their bodies are more likely to function well. Midwives help women achieve that confidence.

Kerstin Peterson is a freelance writer and editor in Prince George, BC. As coordinator of the Association for the Improvement of Maternity Services in BC (AIMS BC), she works to promote woman-centred care. She can be reached at info@aimsbc.org.

Source: alive #257, March 2004