A Woman's REAL Right to Choose

Did you think that I was going to talk about abortion? Wrong. I'm talking about a woman's right to choose how she gives birth.

I know I've touched on this topic briefly before, particuarly when I was doing my obstetrics rotation in a tertiary care centre. I saw so many bad outcomes in both high and low risk pregnancies, it seriously biased my view of childbirth. For quite some time, I thought that if I were currently pregnant I would chose an elective c-section over labouring. For me, I prefered the idea of predictible risk against the idea of unpredictible risk. A c-section is a higher risk procedure than uncomplicated vaginal birth overall, to be certain. But an elective c-section is a lower risk procedure than an emergency c-section (meaning any c-section done for medical indications after labour has started) and it's impossible to predict beforehand if your birth will be one of the uncomplicated vaginal ones or if it will get complicated as your labour progresses.

In Chatelaine magazine this month (did I mention I'm a total magazine whore?) columnist (I refuse to call her a journalist) Rebecca Eckler waxes poetic about her elective c-section. People, for the most part, are horrified that she is 'too posh to push'. I have to disagree. Why mock her motivation for chosing a c-section? No where in the article does she say that she doesn't want to mess up her eye makeup by labouring or anything that implies that she made her choice based on aesthetics alone. Granted, some of the 'pros' to elective c-sections that she mentions do seem a little superficial (like knowing exactly when she'd be giving birth, being able to plan her mat leave accurately, knowing when her mother should come and visit) but who are we to judge?

I'm all about giving patients the choice. Like when it comes to Vioxx. Vioxx was a drug that gave many people with osteoarthritis a new lease on life. Finally, their pain was under control and let them be active with far fewer gastrointestinal side effects than many of the earlier drugs for OA. Then it was pulled from the market under fears of cardiovascular disease. I know for a fact that many people would gladly accept a higher risk of cardiovascular events for the improvement in their quality of life that this medication offered. I also know that I'm not alone in wishing that this medication were still available so that patients would have the choice.

But I'm going off on a tangent. I know, so unlike me.

The health care system has evolved far beyond the days when the doctor would decide what's best for the patient and the patient wouldn't have any say. Why shouldn't the patient get to decide if they prefer the predictibility of a c-section over the experience of a vaginal birth?

Sure, a c-section has it's drawbacks. It's major surgery-- the recovery period is longer, there are risks associated with any surgery, and there is the threat of wound healing problems. But there are risks associated with childbirth, period-- and the complication rate of elective c-section in low-risk pregnancies is very comperable to the risks associated with vaginal birth. Vaginal birth carries the risk leaving women with urinary incontinence, fecal incontinence, sexual dysfunction, uterine prolapse-- some studies suggest that these complications are less likely in women who were sectioned. And the tearing... ugh! I've seen tears that have ranged from what we affectionately refer to as 'skid marks', superficial tears that don't require closure, to fourth degree tears that penetrate the anal mucosa. And that's if you're lucky enough to tear downwards. Clitoral tearing is also a possibility. Then there's always the potential for the stellate tear (I'll give you a hint... stellate means "star-shaped") and the ever-horrifying perineal blowout.

Sure, natural childbirth can be a beautiful thing. But that's not a guarantee.

I know I'm singing a different verse of the same old song. But if the pros and cons are laid out for expectant women in a non-biased way, why shouldn't they have the right to chose?

Now if only I could figure out how to reconcile the increased costs to our overburdened health-care system that c-sections would carry...