Tag Archives: cesarean

Australia

Neighbors, north of Sydney

Neighbors, north of Sydney

Just back from three weeks Down Under, where I was invited to address the Rural Health West Annual Conference in Perth. The theme this year was “Children of All Ages: Health Across the Continuum in Rural Communities.” It was a wonderful experience, and I’m grateful to Belinda Bailey and the organizing committee for their warmth and hospitality.

I gave the keynote address (“Unintended consequences: How mode of delivery impacts long-term child health”) on the mounting evidence that cesarean birth increases the risk of a number of chronic illnesses later in childhood. (For previous posts on the subject, see here and here.) Lots of discussion followed–the cesarean saga in Australia has paralleled that in the U.S., and in sparsely populated Western Australia, where hours-long air transport to a tertiary care hospital is common, decisions about when to intervene in a woman’s labor are particularly challenging. As here in the U.S., a popular movement is pushing back at unnecessary cesareans, or “caesars” as they’re known in Australia.

Later that day I spoke on the history of neonatal resuscitation, a talk loaded with odd historical tidbits, as is my habit… (Did you know that newborn babies in ancient Greece were salted and coated in honey (scroll link to page 82) to protect them from infection? Or that midwives were performing

Perth, From King's Park

Perth, from King’s Park

mouth-to-mouth resuscitation on sick newborns as early as 3,000 years ago? Or that in Germany, the accepted means of reviving a sick newborn until well into the 20th century was to simply swing them up and down?) That talk always gives an audience an appreciation for modern resuscitation equipment.

Perth is a beautiful city, more or less the San Diego of Australia. The weather was gorgeous, and my wife Elisabeth and I did quite a bit of touring around. Became fairly familiar with a number of marsupials, including a few we’d never even heard of. (Numbats, anyone? Quokkas?) We spent a week in and around Sydney, too (over on the east coast, for those of you not up-to-date on your geography)–another fascinating city. We finished up with four days in a cottage in a national park, which is where my kangaroos-in-the-field photo at the top was taken.

Talking cesareans with new friends

Talking “caesars” with new friends.

Oh, and I actually drove over 400 miles on the “wrong” side of the road without so much as a scratch on our rental car, let alone the fiery chain-reaction pile-up (my fault, of course) that I’d been expecting…

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Filed under Cesareans, Travel

“The Most Scientific Birth Is Often the Least Technological Birth”

Here’s an interesting article on the science and ethics of American childbirth, from Alice Dreger in The Atlantic. It rings very true.

My career as a pediatrician attending births has been one long tale of learning a lot of stuff and then unlearning quite a bit of it. When I started in the late 1970s we went after even mildly distressed newborns like a medical SWAT team, with laryngoscopes, oxygen masks and umbilical catheters flying, snatching our pint-sized patients from the jaws of…what, exactly? In retrospect, a lot of them would have been just fine without us. Maybe even better off. (And just to be clear, a lot of them really needed the help, too…)

Things have changed remarkably since then. More and more studies support the wisdom of a patient, mother-centered approach to childbirth, though you wouldn’t know it from current epidural, induction and cesarean rates. Some of the refusal to accept what the research clearly tells us has to do with the way new doctors are often still taught to view childbirth: as a dangerous process in need of strict control. From the article:

“Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.”

Add in the fact that you’re frequently scared to death as a med student and find technology a comfortable/comforting suit of armor to wear, and it’s not surprising that young doctors often live in fear of normal childbirth. I know…I was there. It only takes one bad outcome to make an aggressive approach look attractive, particularly when that’s the medical culture in which you’re being educated.

Dreger’s article is all the more interesting because she’s a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine, and her husband is an academic internist–not exactly the stereotype (e.g., the “woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus,” as Dreger puts it) associated with midwifery and low-intervention births. But when Dreger and her husband did an extensive review of the scientific childbirth literature in 2000 and found that it supported just that–a low-intervention approach–they put what they learned into practice with the birth of their own child.

There’s a place for technology in childbirth, certainly, but most pregnancies don’t need nearly as much of it as they get in the U.S. these days.

Have a read–it’s a great article.

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Filed under Cesareans, Maternal-child health, Natural childbirth, Science