Kidspot Birth

Do early caesareans really have to be called 'harmful care'?

Kimberley Gillan |

Caesareans may seem scary and even harmful, but what if they were the best option for your labour?

Woman has c-section live on-air00:08:25

The moment a woman gave birth via c-section has broadcast live on-air.

If you were to pour a cup of tea amongst my girlfriends, you probably  wouldn't be hearing the word 'harmful' in association with the word 'caesarean'.

While some of us who have had vaginal deliveries have commiserated over prolapses and tears, in my experience, those in the elective caesarean camp largely report 'civilised' experiences

The word association has come to light after the insurance industry earlier this year called for Medicare to ban elective caesareans done before 39 weeks, calling it "harmful care".

It's important to note that obstetrician guidelines do suggest waiting until 39 weeks unless there is a medical reason for doing an earlier c-section, given there is an increased risk of respiratory distress in babies born earlier. 

c sections

Insurance companies are calling to ban elective c sections before 39 weeks. Source: iStock.

Is it really 'harmful'?

But at first glance, it's easy for women (like this writer) to see the words 'harmful' and 'caesarean' in one sentence and have a gnawing sense that we'd be irresponsible if we were to make a c-section choice in future.

In my case, my first baby measured off-the-charts at our third trimester scan leading my obstetrician to gently suggest I could have an elective caesarean if I chose. I immediately shut that option down, since I was far enough through my empowering Lamaze birth classes to trust that my body knew how to get this baby out, come hell or high water.

Check out this mum who broadcast her c-section live on TV. Plus, see why this first time mum who had a c-section was told she took the 'easy way out'.

Well, it took almost two days and some forceps to get my big boy out and afterwards I was incredibly tender for many weeks (but completely stoked with myself for such a marathon effort and for making a bona fide angel). 

But by four weeks, my pelvic floor was still so weak that I ended up with a prolapse (like one in two women who have been pregnant). I felt ripped off – I'd chosen the option that was supposed to be painful at the time but have a far easier recovery. 

I wondered if I'd been too hasty ruling out a caesarean, especially since friends who had had babies "out the sunroof" reported far easier recoveries than I seemed to be having. 

c section

I felt ripped off. Source: iStock.

C-sections are a major decision

ABC talkback callers around the time of the announcement shared their reasons for needing "elective" caesareans prior to 39 weeks, and they were largely about legitimate mortality concerns for mother and baby.

But in all the calls I heard while bogged in Melbourne peak hour traffic, it struck me that a story that is less frequently told is the also-legitimate request for a caesarean for psychological or pelvic floor protection.

Heba Shaheed, pelvic floor physiotherapist known as The Pelvic Expert, prefers caesareans be called 'planned' or 'unplanned', as opposed to 'elective'.

"In my experience, most women who have had caesareans have given it a lot of thought," she tells Kidspot.

"They may have elected to do that because they heard their sister had a third-degree tear or their mum had a prolapse and they don't want to end up like that."

pregnant woman

Women's opinions and decisions may be influenced by other factors. Source: iStock.

Discuss it with your doctor

Obstetrician Dr Joseph Sgroi says that if women are concerned about prolapse or tearing, they should discuss it with their healthcare provider. 

"Every woman’s birth experience is unique to her; and no woman should be judged for the experience she has or the experience she chooses," he told Kidspot

Dr Sgroi says women's labour fears can often be alleviated with education about pain relief options or trying to coordinate a date, as well as highlighting the fact many women have very straight-forward labour recovery. He also says that while a vaginal birth increases a woman's risk of having a prolapse in the short-term, in older age, changes in oestrogen levels can mean women who have had caesarean births can still suffer prolapse later in life.

Unless there is an urgent medical need for an early caesarean, Dr Sgroi says it's worth waiting until 39 weeks. He also notes that when electing a caesarean, a woman's future family plans may also need to be taken into consideration given there are some risks of having multiple caesareans because in a small number of cases, the placenta adheres to the old scar.

"[Healthcare professionals need to] invest time in explaining the benefits and risks of caesareans and vaginal births," he says. 

"At the end of the day, if the decision is to have a caesarean section, accepting that it's the woman's right to choose that is important." 

Shaheed says women's health physiotherapists can help women make evidence-based decisions on their risk profile for a vaginal birth.

"I can give her a picture as to whether she will be low risk or high risk for a pelvic floor injury [based on] her family history, her own pelvic floor, her size and the baby's size," she explains.

"Then she can make a decision based on what she feels is in her best interest, and is safest for her pelvic floor."

c section

The mother must decide what is best for her. Source: iStock.

Education is key

That said, Shaheed says that with good pelvic floor education and helpful birth strategies, a lot of women can avoid birth injuries in the first place, or recover from them seamlessly.

"A lot of birth injuries are totally preventable – it's about learning proper birth techniques, such as stretching your pelvic floor before birth and active labour techniques that can make a big difference," she says.

"In most cases, having a vaginal birth is healthy and safe."

Two years after my labour journey, I'm pleased to say the kegels have done their job and I can now jog and star jump with the best of them.

As to which direction I would take for any future births I'm lucky enough to have, I'm not entirely sure. What I do know is that I'll be canvassing a lot of professional opinions to make an educated decision about what's going to be the least "harmful" option for my baby and my body.