Published Jun 1, 2004
Transcript: Mother's choice
May 30, 2004
Reporter: Liz Hayes
Producer: Richard Mortlock, Glenda Gaitz
INTRO — LIZ HAYES: It seems that doing what comes naturally doesn't come all that naturally these days, not in childbirth, anyway. Now, one in every four Australian babies is born by caesarean section. That's via the scalpel, the knife. Major surgery, but arguably, no more risky than nature's way.
Why? Well, there's lots of reasons, many of them medical. But there's also fear, fashion and convenience, the ability to slot birth neatly into a busy life. And that's where the battle lines are being drawn, with some traditionalists warning that soon, natural childbirth could be history.
STORY — LIZ HAYES: For Vanessa Gorman, this operating theatre is a happy end to a tragic journey. It's the birth of her son Rafael and while having a caesarean birth is a decision more and Australian women are making, it was never a simple choice for Vanessa.
So you made a decision for a caesar?
VANESSA GORMAN: Yes, yes, and I was sorry in a way that I was having a caesarean for him, for my son, but I just thought also that I just couldn't live through losing another child. And I just felt like I have to choose the very safest way and that seemed to be the caesarean.
LIZ HAYES: Vanessa Gorman is a documentary maker. Four years ago, she made an extraordinary film about her first pregnancy, called Losing Leila. It told of her long and difficult labour and her desire to experience a natural childbirth.
VANESSA GORMAN: I thought that having a caesarean, you know, was just maybe not going through that passage, that initiation into womanhood.
LIZ HAYES: After 20 hours of hard labour, Vanessa's daughter was in serious distress. The doctor's only answer was an emergency caesarean. But the operation came too late for tiny Leila.
VANESSA GORMAN: I felt like I was so distressed that that might have put her into distress and … put her into distress and eventually caused the meconium inhalation, which eventually killed her.
LIZ HAYES: Do you wish now that you'd had a caesarean or is that an unfair question?
VANESSA GORMAN: Of course I do. You know, of course I do in that sense of, what if I just had a caesarean, I would now have a four-year-old girl here.
LIZ HAYES: From Leila's death to Rafael's elective caesarean birth, Vanessa Gorman's experience provides a snapshot of how and why Australia's way of having babies has changed.
Do you think we will reach the point where the majority of babies that come into this world will come via a c-section?
DR DAVID MOLLOY: I think we're going to go close to that. I think if you look at almost any part of society, people choose technology. They choose mobile phones. They choose high-tech cars. They choose gadgets for their houses. We're a very technology-driven society. We're comfortable with intervention and technology and I think that's extended, I really believe that's extended into the birthing process.
LIZ HAYES: Brisbane obstetrician David Molloy says when it comes to caesareans, it's a woman's right to choose. Today, it's a choice that one in four Australian mothers are making.
DR DAVID MOLLOY: Caesarean section rights have risen in Australia virtually every year for the last 15 years. First of all, the big driver at the moment is patient request. Secondly, the litigation aspect: we get sued only for not doing caesarean sections or for not doing them quickly enough. The third thing is the ageing obstetric population: now, one in four women or one in five women are having their first baby over the age of 35.
LIZ HAYES: No matter which way you cut it, a caesarean is a serious operation. Here, Dr Molloy is delivering twins. Anaesthetised from the waist down, this mother feels no pain as her newborn son is pulled from the incision made through her abdomen and womb. Like more than 14 percent of Australia's caesarean births, this was elective surgery, the mother's choice. The fact of the matter is that vaginal births and caesareans are seen as as safe as each other.
JUSTINE CAINES, NATURAL BIRTH ADVOCATE: Absolutely not. There is no way that undergoing surgery, major abdominal surgery, can ever be as safe as normal vaginal birth. What we are seeing is that for the convenience of large organisations, ie. major hospitals and practitioners, that women are slotted in. It's basically production-line birth.
LIZ HAYES: For Justine Caines, caesareans are just not natural. This natural birth advocate is a mother of four. Little Tobias was born at home with only a midwife attending.
JUSTINE CAINES: Birth is seen as a very painful, scary thing that's to be endured. And we are a society of instant gratification, quick fix, and birth is not about that and I think that what we're seeing as the result of the quick-fix birth is huge rates of postnatal depression, problems with bonding, breastfeeding and essentially mothering. I believe, and evidence backs me up categorically, that vaginal birth is safest, safest under normal conditions, and I don't believe that Australian women are being told this. I think we have a culture that shows, or that tells women, that caesarean section is safer and easier and that, clearly, is not the case.
LIZ HAYES: Opponents of caesareans say you've been lied to, have been duped.
TRACEY CURRO: By whom?
LIZ HAYES: Your doctor. Your doctor has considered this convenient for him or her.
TRACEY CURRO: Oh, look, you know, that's, that's a bit of a silly old argument really, that it's about, you know, doctors wanting to, or obstetricians wanting to be able to make it to the opera or have their regular Friday game of golf. Look, a doctor can't make this decision for a couple. What's important is that women are able to make an informed decision and that whatever decision they make it's the right one for them.
Mila was only about four weeks old there.
LIZ HAYES: Former 60 Minutes reporter Tracey Curro was 35 when she had her first baby by caesarean.
TRACEY CURRO: A 10cm incision.
LIZ HAYES: Is that all it is?
TRACEY CURRO: Yes, and just below…
LIZ HAYES: The navel?
TRACEY CURRO: Further down, actually. Just below the bikini line!
LIZ HAYES: When you look at this wall, there's no time when you say, "Gee, I wish I had a natural birth?"
TRACEY CURRO: Of course not.
LIZ HAYES: Why did you decide on caesarean births?
TRACEY CURRO: There was some compelling medical reasons why it was a good thing for me. But I had to be convinced that it was also going to be the safest for my baby.
LIZ HAYES: And am I able to ask what your compelling medical reasons were?
TRACEY CURRO: Oh, absolutely. Preservation of the pelvic floor. I certainly think that this is like the last no-go zone in a vast territory of secret women's business. Women don't readily discuss pelvic floor dysfunction. And it's quite ghastly, really.
LIZ HAYES: Now a Melbourne newsreader, Tracey says that although she has no regrets about having both her children by caesarean, she is aware that other women feel differently.
TRACEY CURRO: The questioning tends to go, when you've had a baby, people say, "How was the birth? Was it a difficult labour?" And I say, "Well, actually, I didn't go into labour, I had a caesarean." And the reaction is almost invariably, "Oh. Oh." And I say, "No, no, no. Don't feel sorry, I wanted it and it was wonderful."
LIZ HAYES: But caesareans, or c-sections, don't come without risk. And the risks to the mother increase with each successive operation. There is new evidence that our rising caesarean rate is seeing an increase in emergency hysterectomies, leaving women infertile. Tammy Timberlake had her son Charlie by c-section, but the scar tissue it left would cause massive problems. When she had her next caesarean, Tammy began haemorrhaging. The only way to stop it was to remove her womb.
Tammy, do you recall how you felt about that news? Do you recall being told?
TAMMY TIMBERLAKE: I do, but it wasn't until a couple of days later that it really registered that really, that was it. So I just dealt with it. But I do struggle with it now, because I have friends that are having more children and I know that I can't do that and my children are my life and that's all I want to be, is a mum.
CRAIG TIMBERLAKE: I felt very sad for Tammy. Like, she mentioned we were planning on having more children and her kids are her life, so straight away, what we were planning for the future stopped right then and there.
LIZ HAYES: Isn't it the case that with multiple caesareans, there is a greater risk of a hysterectomy?
DR DAVID MOLLOY: That may be so, but when you're looking at an average birth rate of 1.7 per couple, there's not many of those around and personally, I mean, I've only done two hysterectomies in the peri-partum period in 22 years of practice.
LIZ HAYES: So it's extremely rare?
DR DAVID MOLLOY: It's a very rare operation, fortunately.
LIZ HAYES: In this debate, there are no easy choices. The potential problems of a caesarean must be measured against the complications that can develop during natural birth. For Vanessa Gorman, this was the dilemma she faced in the months before the birth of her second child.
VANESSA GORMAN: Every time I thought about giving birth, my body would just freeze up in fear, really, because after I'd lost a baby, I had done a lot of reading and I sort of knew everything that could go wrong in birth and cord strangulation and, you know, unexplained stillbirth. I sort of knew too many things that could go wrong.
LIZ HAYES: Doctors say it's a trade-off between caesarean risks, which are infection, abdominal pain and epidural risks, and vaginal births, which have the risks of urinary, bowel, and sexual dysfunction. Do you see it like that?
JUSTINE CAINES: I absolutely don't see it like that.
LIZ HAYES: Is that because you've had a great time with your births?
JUSTINE CAINES: No. What has happened is our culture has reinforced that caesarean section is safer and, as I said, that is absolutely against evidence and I think that practitioners are buying into this because it's also easier for them, so I don't think it's a fact that women necessarily disagree. I don't think that they're informed.
TRACEY CURRO: I heard that you did a perfect, perfect job of delivering your lines... Personally, I don't subscribe to the notion that a vaginal birth is some kind of right of passage to complete womanhood, you know, or to being a real mother. Everything that makes it, having children, a priceless experience begins after they're born.
LIZ HAYES: While birth for most may be miracle enough, for Vanessa Gorman, the life a caesarean gave her is something she cherishes every day.
You don't feel guilty at all about not having a natural birth?
VANESSA GORMAN: Um, I don't feel guilty because I tried to have a natural birth and I went through, sort of, 20 hours of hell. I feel like I've been there and done that. I've done the hard yards. I feel unlucky and I feel lucky that I have a live baby now.
LIZ HAYES: But no regrets?
VANESSA GORMAN: No regrets. There's a little blonde, beautiful boy in there and he's the reason that I have absolutely no regrets.
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