March 9, 2005
Birth by design
By Maureen Finn
When Rebecca Eckler learned she was
pregnant two years ago, she became paranoid about giving birth. "I
was having nightmares and stress attacks over it," says the National
Post columnist. "I was really terrified of the pain and of being in
labour for a long time."
|Photo by CBC News
|Rebecca Eckler chose to give birth to her daughter
via cesarean section.
Eckler knew early in her pregnancy that she wanted to have a cesarean section.
She shared this desire with her Toronto obstetrician, but he refused to
do the procedure. "He jokingly told me I'd have to move to Brazil,"
she said in a phone interview from Calgary.
Eckler is one of an increasing number of Canadian women opting for elective
The rate of elective cesareans is on the rise in Canada and worldwide.
The World Health Organization says that a rate above 15 per cent signals
"inappropriate usage." But the rate in Canada is more than 25
per cent and rising - that's up from 15 per cent in 1979, according to
the Canadian Institute for Health Information. The rate in Brazil is now
more than 32 per cent and in some private clinics it's up to 75 per cent.
Some of the increase can be attributed to a new policy that recommends
delivering all breech babies by cesarean section, says Dr. Bryan Richardson,
professor and chair of obstetrics and gynecology at the University of
Western Ontario. Furthermore, there is now greater resistance by both
patients and physicians to allow a trial of labour after a previous cesarean
section and there is also far less use of forceps in deliveries today,
Other reasons include the fact that surgical procedures have become safer,
information that is available on the Internet is influencing patients,
and so is an increase in the media coverage of elective cesarean sections,
says Dr. Robert Di Cecco, obstetrician and gynecologist at St. Joseph's
Health Care in London.
Celebrity births are also influencing expectant mothers. The term "too
posh to push" was coined after Victoria Beckham, formerly Posh Spice
of the Spice Girls, allegedly elected to give birth to her three children
via cesarean section.
"There are supermodels who have their babies at 36 weeks because
they don't want to get too big and they want to have a small baby,"
Di Cecco says. "It's also a time and convenience issue. There's a
certain number of (celebrities) that are having elective cesarean sections
because it fits with their careers better."
Convenience is one of the main reasons Eckler wanted to have a cesarean
"I really like to know when things are happening," says Eckler,
author of Knocked Up: Confessions of a Modern Mother-to-be, a book in
which she divulges her debate about whether to have a cesarean section.
"I really wanted it to be planned," she says.
After moving from Toronto to Calgary, Eckler asked her doctor there if
he would perform the procedure.
"He agreed immediately," she says. "He told me he was surprised
that more women don't ask for them."
Eckler was relieved that he granted her request. "I really liked
knowing that on Oct. 15 I was going in at 9 o'clock and that my baby would
be born," she says. "It was all done within an hour."
Critics of elective cesarean sections argue that the procedure is making
a natural process more complicated, that benefits to babies passing through
the birth canal are forfeited and that performing an unnecessary surgical
procedure is unethical.
Vaginal birth was designed as a natural process, says Dr. Jon Barrett,
chief of maternal fetal medicine at Sunnybrook and Women's College Health
Science Centre in Toronto. "I don't think you have to look at the
benefits of a natural processit's really the other way around. Can
you prove it's more beneficial to have a baby any other way?"
Some of the benefits of vaginal births include maternal-infant bonding
and less risk of breathing difficulties. Some risks include urinary or
fecal incontinence, vaginal tearing and the rupturing of a previous cesarean
Barrett also points out that birth injuries that may be thought of as
more common with vaginal births can still happen with cesarean sections,
such as brain hemorrhages and bone fractures.
But proponents argue that all women should have the choice to give birth
Cesarean sections reduce the chance of stillborn births, fetal heart abnormalities,
the umbilical cord cutting off oxygen to the baby and any damage to the
infant due to labour. They can also be lifesaving. Problems like fetal
distress, placenta previa (when the placenta is covering all or part of
the cervix) and breech babies can all be reasons to have a cesarean section.
However, it is major abdominal surgery. Risks include infection, problems
during future pregnancies, blood clots, hemorrhaging and wet lung syndrome
- a condition in which babies who do not experience contractions during
birth do not clear fluid from their lungs, resulting in the need for oxygen
Eckler says her cesarean section went smoothly and she has no regrets.
She gave birth to a healthy baby girl who is now 16 months old. Eckler
says healing from the cesarean section wasn't too painful, but she did
have trouble walking for about a week. She doesn't think it matters how
any baby is born, as long as it's in a way that women are comfortable
with and it's safe. Now the only evidence of the way in which she gave
birth is a small scar, about 10 centimeters long, that she says is hardly
Eckler believes it is extremely important that women always have the option
of a cesarean section. If she has another child she says she'll do it again.
"But I am still kind of curious about giving birth (vaginally) too,"