The fear of giving birth
"'I died, but it was fine," a woman at a barbecue told me when I was nine months' pregnant."
'I died, but it was fine," a woman at a barbecue told me when I was nine months' pregnant. She was a stranger, her story unsolicited. As I nodded and nervously sipped a glass of water, she explained how she'd suffered from pre-eclampsia, "died" on the obstetrician's table and been brought back to life.
Hers was only one of numerous unsolicited stories that would have been enough to act as excellent birth control, had that ship not already sailed.
"I had two C-sections. I still can't sit up," a waitress announced on seeing my burgeoning belly. "You'll never be able to have decent sex again," lamented one. "Just say yes to the epidural," warned another.
Funny how our own personal experiences become The Big Truth.
There is a dominant philosophy in the Western world that says birth is something women survive, not something they actively take part in or, heaven forbid, enjoy. As fewer women experience natural birth, with caesarean section rates having more than doubled in the past 15 years (now 31per cent, more than 40per cent in private hospitals), fewer Australian mothers will have a different tale to tell.
Those who chose natural births, particularly outside hospital, are commonly dismissed as hippies, insane or worse, so it can be easy to forget that the "survive it; don't expect to enjoy it" philosophy is not held by everyone who has given birth, let alone women in countries where natural birth is more popular. In Nordic countries the caesarean rate is less than half ours, at 14per cent, and in the Netherlands, 30per cent of mothers experience planned home births in the presence of midwives.
A report on the results of 22 international studies, published in a recent edition of the Australian Health Review, revealed something curious. It found that low-risk pregnant women being cared for by midwives were more likely to have a normal birth than equally low-risk women being cared for by a doctor. Dr Meredith McIntyre, of Monash University, said this and "the need to curtail the financial extravagance that comes from treating most women as if they need specialist medical care to give birth safely when many do not" had prompted the federal government to announce major reforms of maternity care.
Cost-cutting is no reason to rob women of birth choices and there is no doubt that interventions save the lives of mothers and babies every day. In Africa, for instance, where the caesarean rate is only about 9per cent, greater intervention would prevent a significant number of deaths. But the World Health Organisation, which estimates the "ideal" rate of caesarean births to be about 15per cent, says there are concerns that go beyond the financial.
The WHO says women undergoing caesareans that are not medically necessary are more likely to die or be admitted into intensive care units, require blood transfusions or encounter complications that lead to hysterectomies. In China nearly half of women give birth by caesarean, a rate WHO blames in part on the higher fees paid for the procedure.
The perspectives of maternity caregivers vary dramatically. One mother I interviewed said of her birth: "I chose an elective [caesarean] because as a doctor I did gynaecology terms and then I did a postgrad dip. in obstetrics: I saw all the worst cases that women have to go through."
Dr Hannah Dahlen, associate professor of midwifery at the University of Western Sydney, had a different outlook. "The amazing thing for me is [that] after 24 years of working mainly in hospitals and seeing so much fear, I now hardly ever see it when women birth at home ... Women get to climb their own Everest in birth and we rip them off so often by not putting into place systems of care and birth environments that will enable them to get there."
I was one of the "just survive it" mentality, which may be unsurprising after so many dramatic stories reinforced my every fear. Then I attended a course called Calm Birth (No, I am not being paid to spruik it) recommended by my obstetrician, who saw that it regularly helped reduce birth trauma and medical intervention in her patients. In the end I was able not only to survive the birth of my daughter but enjoy it. And none of the horrors I'd been set up to expect came to pass.
On one level, the "just survive it" mentality and rising fear of childbirth is paradoxical, as perinatal morbidity and mortality for mum and baby have become very rare, particularly in countries like Australia where birth outcomes are excellent, with about eight women per 100,000 dying due to pregnancy, birth or postnatal issues. We have a perinatal mortality rate of less than 1per cent across all births, with most of these deaths attributed to prematurity or congenital malformations. Low-risk women have only about a one in 1000 chance of losing their baby in labour.
Yet I was not alone in my fears. According to experts, "tocophobia" or fear of childbirth is on the rise. A reported 80per cent of women express common childbirth anxieties (Saisto and Halmesmaki, 2003) and up to 10per cent of women report "pathological levels of fear".
In today's confessional culture, extreme stories are always retold with greater frequency than what is more common and positive. The "I died but it was fine" mum had been telling her war story to unsuspecting pregnant women for two decades. But perhaps the oft-repeated war stories about birth aren't as harmless as some believe.
In otherwise healthy and normal births, fear can lead to low levels of oxytocin, a hormone involved in lovemaking, breastfeeding and in the normal stages of labour. Fear is also known to lead to lower levels of pain-relieving endorphins and higher levels of adrenaline, which can lead to panic, increased pain, lengthening labour and foetal distress.
Says obstetric physiotherapist Juju Sundin, "The fear each woman has as she enters childbirth will have a direct relationship to the progress of labour."
Birth is different for everyone. My experience does not define your experience and vice versa. There is no right or wrong way to approach birth – whether that means a planned caesarean or a medically supervised home birth – as long as we make informed choices based on evidence-based advice. More than ever, women need to consider what is right for them and their babies. And forget the war stories.
Tara Moss is the UNICEF patron for breastfeeding for the Baby Friendly Health Initiative.
From: The Sydney Morning Herald