Caesarean: Just Another Way of Birth?

219 Pages·2007·1.54 MB·English

by  Rosemary Mander

Caesarean
About one quarter of births across the UK, Europe and the USA are now by
caesarean and the debate provoked by the steadily escalating rates invariably
produces more heat than light. The multitude of interested parties – midwives,
obstetricians, parents, activists and managers – means that the many different groups
talk at cross purposes and without listening to each other.
Through this controversial book, Rosemary Mander, a practising midwife and
researcher, seeks to find the meaning of caesarean. It critically analyses the place
of caesarean in contemporary childbearing and questions the changes that are taking
place in childbirth. It explores, in particular, the effects and implications of the
increase in caesarean births, and includes discussion of:
• the context of the operation and repercussions
• caesarean rates around the world and their relation to health systems
• decision making and cultural/medical constraints
• the short- and long-term implications of caesarean for the woman and her baby.
Using a strong research evidence base, Rosemary Mander concludes that the
caesarean may not necessarily benefit either the woman or her baby. Rather, it
may benefit those professionals whose investment is in extending the range of their
influence.
Caesareanis accessible to a range of readers and will be of particular interest
to the health care provider and the childbearing woman.
Rosemary Mander is Professor of Midwifery at the University of Edinburgh,
Scotland. She is both a practising midwife and an active midwifery researcher.

Caesarean
Just another way of birth?
Rosemary Mander
First published 2007 by Routledge
2Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
270 Madison Ave, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business
This edition published in the Taylor & Francis e-Library,2 007.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
©2007 Rosemary Mander
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
British Library Cataloguing in Publication Data
Acatalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Acatalog record for this book has been requested
ISBN 0-203-96076-9 Master e-book ISBN
ISBN10: 0–415–40135–6 (hbk)
ISBN10: 0–415–40136–4 (pbk)
ISBN10: 0–203–96076–9 (ebk)
ISBN13: 978–0–415–40135–7 (hbk)
ISBN13: 978–0–415–40136–4 (pbk)
ISBN13: 978–0–203–96076–9 (ebk)
Contents
Acknowledgements ix
Introduction 1
1 ‘The game of the name’ 4
1 Beginnings 4
1.1 Terminology 4
1.2 History 6
1.3 Changes in caesarean rates 11
1.4 The significance of caesarean 13
1.5 Conclusion 17
2 What arethe questions and who’s using the answers?
Research into caesarean 18
2.1 A‘health warning’ 18
2.2 Randomised Controlled Trials and Evidence-Based Practice 19
2.3 Research ethics and caesarean 21
2.4 The origins of caesarean research 23
2.5 Research topics 26
2.6 Areas yet to be researched 35
2.7 Conclusion 36
3 The caesarean operation – issues and debates 38
3.1 Time factors 38
3.2 Indications for performing a caesarean 42
3.3 Surgery-related issues 46
3.4 Conclusion 56
vi Contents
4 International matters 57
4.1 International background 57
4.2 Comparisons between countries 63
4.3 Discussion – a UK perspective of the international issues 75
4.4 Conclusion 80
5 Caesarean decision making – who’s choosing the choices? 81
5.1 Dynamics of decision making 81
5.2 Clinical, interpersonal and individual decision making 82
5.3 Maternal choice/request/demand for caesarean 99
5.4 Other factors influencing the caesarean decision 104
5.5 Non-consensual caesarean 109
5.6 Higher order decisions 111
5.7 Conclusion 113
6 The immediate implications of caesarean 114
6.1 The implications for the woman 114
6.2 The implications for the baby 126
6.3 Mother and baby 129
6.4 Maternal mortality 130
6.5 Iatrogenesis 131
6.6 Conclusion 134
7 The long-term implications of caesarean 135
7.1 Implications for the woman 136
7.2 Implications for the baby 147
7.3 Implications for others 149
7.4 Consumer groups 153
7.5 Conclusion 154
8 The significance of trial of labour and VBAC
(vaginal birth after caesarean) 156
8.1 Words and the woman 156
8.2 Research matters 159
8.3 Health issues 164
8.4 The significance of safety 167
8.5 Conclusion 171
Contents vii
9 Conclusion 173
9.1 The status of caesarean 173
9.2 Long-term developmental views of caesarean 174
9.3 Medicalisation and women 176
9.4 Risk 179
References 180
Index 205

Acknowledgements
Iacknowledge the inspiration of the women and the midwives with whom I have
had the privilege to practise. I have learned more from them than they will ever
realise.
Although this book is my responsibility, I would like to thank the following for
sharing their thoughts, their ideas and sometimes their work with me: Agency
for Healthcare Research and Policy, Alison MacFarlane, Beverley L. Beech,
Chryssoula Lemonidou, David Lamb, Debbie Harrison, Deborah Purdue, Ekaterini
Kasidi, Elias Mossialos, Geraldine Barrett, Gian Carlo DiRenzo, Gordon Lyons,
Graeme D. Smith, Irena A. Frei, Irene Calvert, Jackie Baxter, Jane Weaver, Jenny
Newland, Kath Melia, National Childbirth Trust, Ngai Fen Cheung, Norelle
Groeschel, RCM Library, Sheila Kitzinger, Sarah Stewart, Sinead McNally, Steve
Tilley and Wang Liston.
My most profound thanks go to Iain Abbot. His searching questions, while not
always welcomed, may have enhanced the material in the book.