Natural birth or C-section?

Sometime during the past few decades, giving birth became a cold, clinical experience, often involving a scalpel. But leading South African pregnancy advisor Sister Lilian believes midwives should reclaim their place in the birth industry, and once again help women to give birth as nature intended.

It's been said that the greatest work of art created first by God and then by man, is the creation of life. Conceiving a child, and then delivering it, is what humans are programmed to do.

Midwives have been helping women give birth since the beginning of time. But over the past few decades, this role has been overtaken by obstetricians, and, in many instances, midwives have taken a step back as the primary role-players in the birthing process.

We're now at a point where birth by Caesarean (C) section has overtaken vaginal births in private hospitals in this country, and with a C-section rate of 60%, we're among the countries with the highest C-section rates in the world.

According to the World Health Organisation, national rates of 15% or more negatively impact mothers and babies: C-sections are associated with a real risk for infection, surgical injury and a longer, more painful recovery period. Babies born by C-section are also at increased risk for breathing problems, and asthma and allergies in later life.

But despite the high C-section rate in this country, Sister Lilian Paramor, renowned midwife, author and pregnancy advisor, believes that more South African women are becoming aware of the fact that surgery isn't always the best option for them. Now, they just have to convince their doctors.

Natural birth: an inconvenient truth
"Giving birth naturally is the most empowering thing a woman can experience," says Sister Lilian. "It has so many benefits for baby and mom, ranging from a reduced risk for colic and post-natal depression to a better relationship with her partner and greater breastfeeding success."

These benefits, she says, could partly be attributed to the fact that women feel incredibly good about themselves after delivering a baby naturally – a privilege that's taken away when women are coerced into having C-sections or traumatic vaginal deliveries that don't take nature's laws into account.

There are many possible reasons for the increase in C-sections in South Africa and around the globe. lists fears of malpractice claims and lawsuits and side effects of common labour interventions as possible reasons (for example, research shows that having an epidural early in labour increases the likelihood of a C-section).

Another possible reason is that natural births can't be scheduled. "The fact is that natural births often take place in the middle of the night, so it's inconvenient for the doctor," says Sister Lilian.

Furthermore, we live in a society that has become too casual about surgery. We've come to view C-sections as "normal", and not a procedure that should only be done for good medical reason.

Natural home births comfortable, safe
Sister Lilian firmly believes that, in low-risk pregnancies, natural birth is the way to go – ideally in the home environment or by means of an active birth unit. In a healthy pregnancy, C-section should rather be the last, than the first, resort.

"Sixty to seventy years ago, few women gave birth in hospital, and hospitals were associated with illness and death. These associations still count today," she says, explaining that a negative association with the hospital setting could create anxiety, which could affect the ease of the labour process.

"Home and natural deliveries, on the other hand, are lovely because the woman is in a space she knows well or can feel totally relaxed in."

The practice of home delivery is often questioned by the medical industry and opposed by obstetricians and gynaecologists, but research shows that, under the right circumstances, the method is safe. For example, a Canadian research study has just shown that the risk of infant death following planned home birth attended by a registered midwife doesn't differ from that of a planned hospital birth.

"Midwives carry emergency equipment and the risk of death is not higher, as shown by research," Sister Lilian confirms.

She also maintains that, in normal, low-risk pregnancies, home birth has its perks. "Women typically experience far less complications, such as slow labour progress and foetal distress. Some people are just more comfortable in their homes, and if the woman has a good midwife, she's perfectly safe.”

At this stage, however, most South African women still prefer to be close to a hospital when they're going into labour. This could be one reason why active birth units, or midwife-led services that co-operate with hospitals and mimic comfortable, home environments, are often employed.

'Give women a choice'
Sister Lilian feels strongly about the fact that doctors and midwives should give women different options, and explain the truthful and accurate pros and cons of the different methods of giving birth right from the start. Settling for the Caesarean path straightaway isn't always the best course of action. "The woman must be given an option A, B and C, and whatever works on the day, is the best plan."

She has a clear message for expectant moms: "Mother Nature is on your side in the form of nurturing hormones, which means you're really equipped to do this thing. Know that the value of enjoying the experience is the thing that can liberate you to change your life. "

And if a natural birth is what it takes to make labour a more joyous experience, then perhaps it's time for more doctors and women to once again consider this option.

(Carine Visagie, Health24, September 2009)

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