Cheating birth or medical magic?

I'm charmed by the Scottish play, but always feel cheated by the witches’ prophesies.  Really - how does carrying a few branches as camouflage constitute a wood moving? 

Worse still is the reassurance that Macbeth should fear “none of woman born”, only for his rival Macduff to be exempted as he was “from his mother’s womb untimely ripped”.  What a rubbish trick!

Nowadays mothers are cast as the cheats:  they’re ‘too posh to push’ so ask surgeons to magic an unnatural birth to keep them honeymoon fresh.

This is particularly controversial in the UK just now, with the latest guidelines (released at Halloween) suggesting caesarians are now so safe they should be offered to all women, not just those with complicated pregnancies.  Midwives are cursing in their covens!

Here I must declare an interest.  Since Katja started her spell as a student I live vicariously as a midwife.  My breakfasts are dominated by birthing options, dinner chat is of breast feeding, even nights out focus on female reproductive anatomy (though not in the same way as most boys on the town). 

But at the risk of being spellbound by my nature-loving sisters, I think there is something to be said in favour of the latest guidance.

My starting point (as with everything) is that pleasure is good, and pain bad. Birthing guru Sheila Kitzinger says a natural delivery should feel better than orgasm.  But the detailed illustrations in midwifery manuals make me wince:  that’s got to hurt!  Surely we must sympathise with any mum who chooses delivery by a quick, safe and relatively painless surgical procedure?

And shouldn't this be about choice?  For years the natural childbirth movement rightly pushed for informed decisions and the opportunity for a ‘normal' birth.  But if caesarians are now so safe and easy, why can’t women choose this - even if some midwives may prefer otherwise?

Not spooked by a four-fold increase in complications, risk of obesity and post-natal depression (as you reflect on the dreadful magnitude of your failure)?  Haunted by wind, allergy to sex, your legs falling off and baby turning into a frog?  Of course pregnant women are not all ill, and must not be beguiled into undue medicalisation.  But as Catherine Bennett notes in the Observer, we should be suspicious of some of the pressure by the natural birth lobby to scare women from dodging a proper labour.

What is a natural birth anyway?  It’s certainly not the sterility of a hospital labour ward or theatre.  But what’s so normal about a thermostatic birth pool, amplified whale music and gas, air, scissors, suction or a waiting ambulance? 

And isn’t science good?  You could argue - as does Cristina Odone in the Torygraph - that nature is flooding my friends in Cambodia just now, not to mention shaking Turkey and plaguing Africa with malaria.  Meanwhile, technology has moved us from quacks to labs, leaches to laparoscopes.  Even if science isn’t better, can’t it work together with nature for a greater good? 

After all, if natural birth is so great, why are we working so hard to reduce maternal mortality in developing countries, where there are so few caesarians?  Please tell me I didn’t waste the last two years!

I’m equally unconvinced that a UK caesarian rate of 25% is simply due to greedy, arrogant doctors tricking vulnerable mums.  This slur could equally (and just as unfairly) be hurled the other way - as by Odone who rants that “beyond their calculated use of mystifying jargon, the midwives' agenda is to keep themselves in business - no matter what the risk to the women in their care”.  This is so not my experience of caring, dedicated midwives or doctors.  Obstetricians are no more bewitching mums into the latest expensive trend than midwives are promoting natural birth just to cloak their own insecurities or to sell kits, birth classes or alternative potions.

Let’s be honest – it really comes down to money.  As a health manager, I have the thankless job of conjuring world-class health services from a Sunday league budget.  I hesitate to suggest home births are cheap, as they disperse skilled midwives and require back-up.  But whilst surgery has economies of scale and location, it also requires an expensive team, kit and drugs (just like any Premiership club).

Even if they cost more, caesarians may be worth it.  Perhaps Odone has a point when she complains that if this were a male operation it would have been freely available years ago.

But dismissal of midwives as “placenta-munching Gaia-worshipping thugs” is hysterical.  Whilst caesarians may become even more common, some women will always choose a ‘natural’ birth.  They will therefore need caring and highly skilled professionals to help them. Natural birth cannot be dismissed as stone-age medicine, and midwives - unlike witches - will not be relegated to the mists of time.