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March 9, 2005

Birth by design

By Maureen Finn
mfinn@uwo.ca

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 cesarean sections.

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, he says.

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 section.
"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 process—it'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 scar.

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 either way.

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 therapy.

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 even noticeable.

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," she admits.