 Dr.
Odent talks about the Caesarean epidemic
by Claudia Villeneuve
Results of an interview conducted on
September 16, 2003, by Claudia Villeneuve for Birth Issues
during Dr. Michel Odent's visit to Edmonton for a public
lecture and a seminar sponsored by ASAC. In this interview
excerpt, he talks about the Caesarean epidemic.
CV: Caesarean sections
save lives, but now they are done for almost any reason.
You have said that "anyone with two hands and a few
instruments can do a Caesarean section: it frequently requires
great intelligence not to do one." Could you explain
this?
MO: It is important to
understand why the Caesarean rate is so high. In places like
United States , Mexico , Brazil , Chile and China , the Caesarean
rate is around 30%. There are three reasons why it is so
high. First, it is such a safe operation. If it wasn't safe
then not many people would do them. Back in the 1950s, Caesareans
became a safe operation. I was trained as a surgeon using
a Cesarean technique, new at the time, called the low transverse
section. As opposed to the traditional cut which was a vertical
one. It became a safe, life-saving operation. The first time
I performed it, the nurse that was with me began crying.
She told me how incredible it was that we could now save
women and their babies in case of emergencies. That was then,
but nowadays Caesarean has become a normal way to be born.
The need to cut the pregnant tummy and extract the baby is
a fixation, a dream, a fantasy of humans. That is the second
reason Caesarean rates are so high. The dream is obviously
not dead. In the legend, Apollo opened the belly of his lover
and that is how his son was born. China has stories about
that too. The fantasy is still here. Even Mattel has a pregnant
Barbie doll, where children can get the baby out of her tummy
through an opening in the belly. The third reason for why
Caesareans are so high is the lack of understanding of the
basic physiological needs of the labouring woman. One is
privacy, the need not to be observed. This is a typical mammalian
need. Mammals, they don't want to be observed when they are
in labour or giving birth. Wild goats, for example, go to
the most inaccessible place in the mountains to give birth.
This needs to be understood by both the medical and the natural
birth community, alike. Another one is the need to feel secure.
If people understood the basic needs of a labouring woman,
they would realize the importance of having a midwife present
at the birth. She represents the mother figure, which instinctively
makes us feel safe. If the need for security was understood,
midwifery would not have disappeared, large hospitals would
not have developed, and birthing technology would not have
developed either. It is basically the lack of understanding
of these needs that has made the Caesarean rate so high.
CV: Should we try then,
to attempt to reduce the rate of Caesareans done?
MO: The priority today
is not to reduce the number of Caesarean sections, because
this is dangerous. The limit set by the World Health Organization,
WHO, is about 10-15% and this has made countries like England
rush to try to reduce the number of Caesareans, when instead
they should reduce the number of difficult vaginal births.
In England , that 10-15% goal made doctors try very hard
to meet the goal. The consequence is that women underwent "everything
available" by medical science to prevent a Caesarean
section, which only causes very bad vaginal births. By this
I mean, the women received a lot of drugs, had forceps and
vacuum used to extract their babies and ended up with vaginal
tears and other injuries. And after all, the Caesarean rate
is still high. The priority should be then to improve our
understanding of the needs of the labouring woman. The goal
shouldn't be to reduce the number of Caesareans but to reduce
the number of difficult births by the vaginal opening. When
baby has a difficult and long birth by the mechanical route,
this is a risk factor for pathological issues for baby, such
as breathing difficulties and low immune system; and physiological
problems for mom, such as uterine prolapse, urinary tract
prolapse and vaginal tears. If we don't ignore the basic
needs of the labouring woman: privacy, security, silence,
low lights and control, the rate of Caesarean sections would
drop by itself. The drop will follow naturally.
CV: A woman's desire to
have a home birth in Edmonton is viewed with dismay or horror
by the majority of the medical community, and so is our desire
to have water births and VBACs (Vaginal Birth After Caesarean).
Imagine how they react when some women choose to do all three
things at the same time. Do you have any comments?
MO: Actually, we found
that the second meaning of VBAC is Very Beautiful And Courageous.
This phenomenon of the Internet, and easy access to massive
amounts of information, has created a revolution in the power
of patients to make decisions about their health. We can
only tell women what we know about Caesareans and VBACs,
then they can choose for themselves. Women can ask their
caregiver what are their chances to get a VBAC. Using a set
of criteria we can forecast their chances. This should be
done case by case. Knowing and understanding the reason for
the previous Caesarean, and other factors, we can give a
woman 10% chance of success or climb all the way to 95% success.
This depends on many factors. What is the risk of uterine
rupture, complications, for example. Well, we have precise
information from papers written for the New England Journal
of Medicine such as never artificially induce labour
with a previous Caesarean section. With an induction, the
probability of rupture is multiplied by a huge coefficient.
High fever after a Caesarean section is a risk factor for
uterine rupture on the next VBAC. We, therefore, don't use
any drugs on these women. Also, immersion in water can make
the birth gentler and reduce rupture too. It is misleading
that we have lumped within the rate of rupture, all windows
and dehiscences which are small, bloodless and benign. Even
if large ruptures occur, babies come out alive. So even within
the 0.5% chances of a "separation," the chances
of a tragedy are very low. The risks of undergoing a Caesarean,
which is major abdominal surgery, are actually worse. In
a way it is a balance of risk. Also, women should ask themselves,
where do they feel safe to give birth? No one can tell them
where to feel safe; that is why sometimes home is the place
to be. Give a trial of labour where a woman feels safe. Another
factor affecting how easy a VBAC labour will be exists among
women who had a chance to experience natural labour before
their Caesarean. It is different for a woman to have a VBAC
after a Caesarean done after labour, or a Caesarean done
at pushing, or a Caesarean without labour. If she had laboured,
on the next time labour is different. It is easier for her.
She has developed the uterine receptors to oxytocin, the
hormone that regulates the contractions. A VBAC is often
worth trying, but if the woman wants a Caesarean, then the
VBAC will be very dangerous. She will be full of fear during
her trial of labour, making it risky, long, difficult and
stressful for baby and mom. If a woman is motivated to have
a VBAC, she is already mentally in a much better position
to achieve her goal. My advice is to give women the data
and let them choose what they feel is right for them.
Dr. Odent is an obstetrician, a midwife,
and a prolific writer. He has been described as a visionary
who seeks small solutions to very big problems. His newest
releases are The Scientification of Love and The
Farmer and the Obstetrician, available in bookstores.
An international speaker who is sought after around the world,
he founded the Primal Health Research Center in London and
publishes a quarterly newsletter which studies the irreversible
effects of fetal life on all aspects of life. His website
is www.birthworks.com.
Article from Winter 2004 issue
of Birth Issues, published by ASAC in Edmonton . Claudia
Villeneuve is a member of the 2005 Executive of the Edmonton
VBAC Support Association.
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