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  1. 1

    Doctor Whom

    I think Norman Swan or some one had a person from Cambridge? just today or on the weekend speaking about rates of caesars related to many women giving birth at a later age these days.

  2. 2

    Ian Haywood

    When I was an obstetric HMO, I remember several times being called by midwives to see a woman in early labour (progressing normally) who asked for LUSCS because they were scared of labour.
    I did my best to reassure them, talk about the benefits of VB, etc., usually not very effectively, being a bloke (and I assume the midwives had already tried), but in the final analysis I stood at the foot of the bed and said “No”. The author seems to suggest this is right, but I’m unsure how this form of medical paternalism differs from other forms that Crikey contributors wouldn’t approve of.

  3. 3


    I don’t have nearly enough information about the subject matter to make an informed comment, but statements like this disturb me:

    “Research also shows rates of post natal depression significantly different between women who birthed vaginally and the group of women who delivered either by planned or unplanned CS. There are also differences in parenting perceptions and behaviour between women delivering by CS and vaginally. Women who birth by CS evaluate their babies less favourably, are less likely to breastfeed and/or feed for a shorter duration.”

    Stay after class and write out 100 times “correlation is not causation”. Much of the rest of the article sounds compelling, but given the above demonstration of how statistics have been mistreated, I’d want to carefully check the sources of the evidence being presented.

    The other thing that I think is counter-productive is insisting that this is a gender issue. It hardly encourages fathers to get deepy involved in the whole process when things are constantly phrased as “choices for women are….” etc. Why is it only women who “can chase evidence themselves, or question doctors, hospitals and midwives”? I’d hope that when and if my wife becomes pregnant I’d would be equally active in this information gathering and decision process. It’s a shame that the author, while clearly passionate about the issue, makes the assumption that my role is over once sperm has been provided.

  4. 4


    In response to Ian Haywood, “No” is the responsible answer in this situation. Would a surgeon amputate a healthy limb or even perform any major surgery on a healthy person unnecessarily? Not all choices are equal and it is the health system who have failed women in leading them to think that they are.
    What is going on here in our maternity system? I am a midwifery student and have just finished working in an obstetric led delivery unit. This is normal, low risk care in a public hospital. I saw hardly any vaginal births, taken over by instrumentals and cesareans. These were not at the request of the women, nor midwives but the obstetric registrars who seem to be practicing emergency care on well women who are unlucky enough to be the recipients of interventionist, invasive treatment. Not even evidence based practice, the AMA have a lot to answer for if they think this is gold standard. Prof Lesley Barclay has won an Order of Australia award and served as a WHO advisor, lets take a little more notice.

  5. 5


    Discussion about choice is often framed as an individual issue in these discussions in a way that doesn’t take into account how the set up of the system can influence “choices”. For eg if there is no continuity of care – the woman sees different practitioners before, during and after the birth, then women in this situation may make different choices to those who’ve had the same practitioner/s providing advice and support through pregnancy, the delivery and in the postnatal period. So it’s not all about individual choice; it’s about whether the system supports and enables the choices that are most likely to be of benefit to the woman and her baby, whatever these may be.


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