Mothers want freedom to choose caesarean

By REBECCA WALSH

Tanya is adamant that she should have the right to choose a caesarean.

As debate continues over New Zealand's growing rate of caesareans, she and other women the Weekend Herald spoke to felt they should be able to choose. A healthy mother and baby are the important things, not the process used to get there, they say.

"I know it's un-politically correct," said Tanya, a 41-year-old expectant first-time mother, but her age, and the probability that this was the only baby she would have, were major factors.

Still, friends and her own mother questioned her choice.

"There is an anti-feeling to caesarean birth, that you are taking the easy option, that you are not a real woman."

The row over elective caesareans erupted this week after a legal opinion that doctors and district health boards should refuse to perform caesareans that are not clinically justified.

The opinion by Auckland law firm Meredith Connell was sought on behalf of 18 district health boards and reinforces the Ministry of Health's view that health professionals should not be offering services where there is no need.

Most specialists believe unnecessary caesareans should be avoided because the operation is major surgery carrying risks such as bleeding and infection.

Midwives and women's health groups, such as the Federation of Women's Health Councils and Women's Health Action, argue that birth is natural and normal. They question whether women are fully informed of the risks associated with caesareans.

Some say "designer deliveries" are a self-centred response to birth, using public money for private convenience.

Nationally, about one birth in five is a caesarean.

At Middlemore Hospital, the rate is about one birth in seven, a figure chief medical officer Dr Ian Brown attributes largely to the high proportion of Maori and Pacific Island people who believe "normal delivery is normal".

At National Women's Hospital in Auckland, the caesarean rate has doubled in 10 years to almost one in three, one of the highest rates in the country.

An Auckland mother in her late 30s who had an elective caesarean said individual women's voices needed to be heard, "not just the pro-natural birth midwives' lobby".

The mother of one said she had never fancied a vaginal birth. It was not so much that she feared childbirth, but if there was an easier way why not take it?

"I don't see the method of giving birth as a defining moment of motherhood. It's the years after that count."

Caesareans cost an average $3000, twice as much as a straightforward vaginal delivery. They are fully Government funded, even if women elect to have one when there is no medical reason.

Parents Centre believes a user-pays system should be put in place for "designer deliveries".

One woman said health boards should set policies on payments, adding that she would have been willing to pay any extra costs.

Mother of two Sandra McKenzie, who experienced two difficult births, one vaginal and the other caesarean, is one of those who believe women must have a choice.

"At the end of the day, all that counts is a safe delivery and a healthy baby and mother. Medical people can argue all they like but at the time it's not them on the table."

FOR

* Clinical reasons, such as the baby being in breech position or a lengthy labour where no progress is being made and a caesarean may prevent damage to the mother or baby.

* Women are having babies at a later age, which means they may be less fit and find it more difficult to push the baby out. Babies also getting bigger, increasing the chances of them becoming stuck.

* A spinal anaesthetic can be used which means the mother remains conscious throughout.

AGAINST

* It is major surgery and carries risks such as bleeding, infection and blood clots.

* Recovery takes four to six weeks and there are restrictions on driving and lifting heavy objects.

* A woman whose first birth is a caesarean is likely to continue to have them.