LETTER
TO AUTHORS: MYTH OF ELECTIVE CESAREAN FOR PELVIC HEALTH
Edmonton, August 17, 2004
Dr. Magnus Murphy
Ms. Carol L. Wasson
Authors "Pelvic Health & Childbirth: What Every Woman Needs To Know"
Calgary, Alberta
Dear Dr. Murphy and Ms. Wasson:
I found your book "Pelvic Health & Childbirth:
What Every Woman Needs To Know" (download at obgyn.net)
in the Edmonton Public Library. I was pleasantly surprised
to see that you, Dr. Magnus, are an assistant professor of
the Department of Obstetrics and Gynecology at the Calgary
Regional Health Authority.
Being a caesarean mother myself, I read
with great voracity all chapters 6, 15, 16, 17, and 18 that
focused on the caesarean debate. Thank you for putting in
print the following:
- "This book supports the concept
that a woman should have the right to choose how her baby
is delivered, whether vaginally or via an elective cesarean
section." Page 176.
- "I completely agree that we should be reducing
unnecessary cesarean sections. By unnecessary, I mean doing
a cesarean for women who really want to have a vaginal birth." Page
200.
- "I strongly discourage the use of cesarean section as a cop-out..." Page
201.
All of these statements are exactly the
kind of support that VBAC-hopeful moms need to hear from
their caregivers. VBAC being vaginal birth after (any number
of) caesareans.
Supporting a woman's right to choose should
include women who after 2 or 3 caesareans have discovered
that they have other non-surgical and gentler birth options
and want to exercise their informed consent to a VBAC. The
current Capital Health ban on VBAC extending to community
hospitals and from certain caregivers is actually a step
in the wrong direction, especially since the majority of
these community hospitals and caregivers still offer elective
caesareans.
Unfortunately, you have also filled your
great book with statements promoting universal caesareans
too:
- "...between 36 and 360 fetuses could
be saved from every extra maternal death that would have
resulted from doing universal cesarean sections at maturity." Page
229.
- "In fact, it seems that there is little difference in satisfaction between
the vaginal birth group and women who choose elective cesarean sections." Page
185.
The debate is not balanced, since in the
current environment women cannot choose to have a gentle
natural birth without having to fight for it. Your own Capital
Health nurses are trained to instruct women on accepting
inductions, amniotomy, IV, epidural, bed isolation, and supine
positions when these are clearly deleterious to a normal
unobstructed labour. The nurses are not trained to massage,
to learn the effects of positive labour psychology or holistic
alternatives to drugs. Your own doctors are not being taught
to deliver unusual births vaginally and of course they cannot
offer a gentle birth anymore except by surgery. This is the
problem.
I looked in your book for references to
Penny Simkin, Michel Odent or Sheila Kitzinger, but I did
not find them. The first person is a professional doula trainer,
the second is a surgeon and researcher, and the third is
an anthropologist. All of them offer non-surgical
solutions to preventing pelvic health disorders at birth
of which you do not even mention one:
- vertical positions for labour and
delivery aided by gravity
- no commanded or rushed pushing but letting the mother follow her instincts
- to assume the squatting position opens pelvis 30%
more (!)
- water birth allows pelvic floor to float freely making it more flexible
during birth
- warm compresses in perineum to relax the mother and not rush a forced birth
Having had the best of both birthing worlds:
a painless active labour and delivery of my first child by
cesarean, and then an active fully-participatory gentle natural
birth with my second child, I am in a position to say that
giving women gentle non-interventitive births will help them
want to avoid elective surgery. No one with a great vaginal
birth even considers an elective cesarean, since they don't
have to fix what is not broken.
It would be great if you added in future
books information on support for gentle vaginal birth and
information on how low-transverse cesareans actually damage
the vaginal nerves for orgasm, and how the mechanics of birth
are amazing and will respond when unobstructed by rushing
and lithotomy-like positions. Please consider if the cure
for the mismanagement of vaginal birth is going to be instead
open-uterus surgery. Surely, medical experts can find a better
way.
Thank you for your attention,
Claudia Villeneuve.
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