Birth wars

There are two camps in the birthing business: those who support natural childbirth, and those who believe that birth must be medically managed. We take a look at the two sides.

Something for everyone
Health professionals should act consistently in the interests of women, but unfortunately, egos and infighting sometimes get in the way.

Dr Trudy Smith, an obstetrician and lecturer at Wits Medical School, acknowledges the existence of two schools of thought: 'The true naturalist, usually a midwife, believes in keeping the birth process totally natural. Epidurals are discouraged; only natural pain relief is used. A physician will encourage medical intervention, because he believes it's nicer for the patient. Both of them are right.'

And both approaches work. Both obstetricians and midwives (and, indeed, your GP) are qualified to deliver your baby. There are as many 'right' ways to have a baby as there are women; the trick is to decide which approach will work best for you. Take Samantha and Catherine – two sisters whose babies were born a week apart.

Samantha: Opted for natural birth
'I'd always wanted a natural birth,' says Samantha, 'And I was fortunate to find a midwife who was happy to deliver my first baby at home, in water, which was my dream. The whole experience was fantastic. Sure it hurt, but at no point was the pain more than I could handle. My husband was with me throughout, and my midwife was great, constantly reassuring and supporting me and explaining what was going on every step of the way. I felt totally in control all the time. It really was the happiest day of my life.'

Catherine: Opted for a caesar
Catherine's experience, while totally different, was no less positive. 'I'm a complete sissy about pain,' she laughs, 'And everyone says having a baby is the worst pain there is. I was determined that I would have a pain-free birth, even if they had to put me under for a week! My gynae was so sympathetic – he says many women feel just as scared as I did.

'As it happened, my due date coincided with our wedding anniversary, so I decided to go in for a caesar on that day. It was great, the whole thing was over in a few minutes, I was awake and involved throughout, but I didn't feel a thing. Afterwards, my husband and I toasted our anniversary and Jade's birthday with orange juice, with our daughter snuggled up to my breast.'

Caesars: A doctor's opinion
Like Catherine's doctor, Dr Jack Pretorius, an obstetrician and gynaecologist in private practice, believes that a woman should have a caesarean section if she wants one. 'I'm easily persuaded,' he admits. 'If a girl says she's too scared, I'll do a caesar. A birth without pain relief is idiotic, and the idea that you don't bond with your baby without pain is absurd; there's no logic in it.

'Long labours went out with the Boer War. A doctor has to be gentle with his patients; it's a joint decision. I'd put all the options to her, but it's her body. A caesarean section is quick and easy; there's no doubt that it's the ideal way to have a baby.'

Natural birth: A midwife's opinion
Strong sentiments, but equally strongly argued from the other side of the fence. Sharon Marsay is a midwife in private practice, specialising in home birth.

'Natural birth is better for the mom and the baby,' she asserts. 'There's no satisfaction in having an epidural caesar. Birth is a right of passage, an adventure, a journey that a woman takes to become a mother. It's not just a physical experience; it encompasses the heart, the spirit and the psyche. How you give birth affects your relationship with your baby, your mother, your partner and yourself.

'It's a battle and it's painful but afterwards you can look back and say "Look what I did!" After a water birth at home the woman can get out of the pool, have a pee, eat something and get into bed with her baby. It's a family event; a celebration. An epidural isn't a spiritual experience!'

Doctors under fire
There's no doubt that doctors have come in for a lot of flak in recent years. In Mal(e) Practice (Contemporary Books, 1981), subtitled How Doctors Manipulate Women, Dr Robert Mendelsohn gets stuck into his profession in a big way. On the subject of childbirth, he has this to say: 'About 95% of the time (doctors) are as superfluous as tailors in a nudist colony... But obstetricians cause the mother pain so that she will need drugs that only doctors can prescribe. They immobilise her so that complications ensue. Then they position her during delivery so that she will need the episiotomy that a doctor must perform.'

Or how about this: 'Most obstetricians resent God's failure to plan childbirth so that they can set foetal office hours and insist that babies arrive between 9 and 5. Many of them remedy this injustice by inducing labour for non-medical reasons, even though it sometimes means that babies won't be born alive.'

And, indeed, horror stories abound of women whose babies were born prematurely because the doctor induced labour before leaving for Mauritius on holiday, or performed a caesar because he was due on the golf course at 2.00pm. But the blame for unnecessary inductions can't be laid solely on the doctors who perform them.

'Many girls say they don't want to be induced,' says Dr Jack Pretorius, 'And I have no problem with getting up at night to deliver a baby. But at least 50% of my patients are dying to get it over by 38 weeks.'

Dr Trudy Smith takes a conservative stand on induction. 'It has a high failure rate,' she says, 'I would have to have a very good reason to do it and social reasons aren't good enough.'

Smith acknowledges that some doctors do disempower their female patients but at the same time feels that some midwives will take unnecessary risks in order to achieve a natural birth. Generally, though, credit is given where it's due.

What is your opinion on this debate? Are you pro natural birth or pro caesarian? Share your thoughts with us in the comment box below.

- Your Pregnancy magazine

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