The great caesaran debate

On Tuesday night, we went to our hospital for an information evening on epidurals and caesarians. Most of the women were there to find out about epidurals in case they decide to have one in labour, some were there to find out about caesarians in case an emergency one is needed, and a small number like me were there because they know they will be having a caesarian.

It didn't get off to a very good start. The first speaker was an anaesthetist, talking about how epidurals are done. He asked had anyone had one and the woman next to me put her hand up. It turned out she had an emergency caesarian with her first child after 36 hours of labour, in that hospital, with that anaesthetist.

It became very clear that she had had a very traumatic experience, and she didn't hold back on it. I wasn't exactly clear on why it had been so bad, but she said she was left alone at one point after the operation with people talking and laughing and no-one listening to her.

This was clearly really embarrassing for the anaesthetist because he was hearing, in front of a room full of people, how his patient had a really awful time. When he explained that the epidural is left in for a couple of days so that the patient can deliver pain relief by pressing on a button, the woman piped up and said she did this and it didn't relieve the pain.

The anaesthetist then said he has at times come to the hospital in the middle of the night when a patient is struggling with pain. I really just had to wonder why she didn't tell someone at the time.

And if that wasn't enough, when the midwife explained we might have to share a room for the first night but then get a single room after that, this woman said she had shared for two nights. What a terrible experience!

I don't know how anyone else in the room felt, but I came away feeling much more apprehensive about the whole business than I might have if she hadn't been there. It wasn't her fault because the anaesthetist did ask her directly how it had all gone, so she had no choice but to answer. But I couldn't help feeling that the information evening with a room full of first timers like me wasn't the time or the place to be airing her grievances against the hospital and specialists.

When we moved on to the caesarian presentation with the obstetrician, the women who are hopeful of not having one dominated the conversation. The tone of the questions was quite aggressive and geared towards how these women can avoid a caesarian because of the evil obstetricians trying to force it on them. One woman said she thought obstetricians were risk averse and the caesarian rate was very high in this hospital and was it related to the obstetricians being worried about their insurance payouts.

The obstetrician did a great job of not getting really angry at this point, but he did give us quite a long and eloquent speech about how things work from their point of view. He said he was lucky in Australia that the medical indemnity pays out without a fight for any mistakes, so he can practice his specialty secure in the knowledge that he doesn't have to modify his judgement because he is worried about being sued.

He also said that believe it or not, obstetricians are most concerned about the health and safety of their patients and babies, not getting to the golf course faster. He also made the point that private obstetricians are a risk averse group but so are their patients. He said people who don't like intervention are better off in the public system and he said he has had patients who have moved to the public hospital for this very reason.

By this stage, I was really quite annoyed. The point of the evening was to find out about how a caesarian works and what to expect, and we had spend well over an hour talking about how to avoid one and the specialists trying to defend themselves in the face of this criticism. Once again, I thought it wasn't the time or the place for women who are trying for a natural birth to get on their bandwagon.

Its fantastic if they can achieve a natural birth with no pain relief and no intervention, and I wish I could too. But when I go to an information evening about the procedures, I don't expect to sit through a debate about the pros and cons. They should be talking to their own obstetricians about how they will personally manage their case.

Anyway, that's my rant. I had a chat to a friend yesterday who has had two caesarians for the birth of her two kids, and she said she went into them with an open mind and didn't worry too much about the details of how it would all happen. Perhaps that's good advice.