According to the WHO, the timescales typically used to define a “normal” childbirth are unreasonable. These guidelines, which date back to the 1950s, say that a normal birth should progress at 1 centimeter of dilation per hour. They’ve been around so long and used so widely that many people accept them as gospel, but now the WHO says that progressing slowly on its own should not be enough to warrant a C-section.
Dr. Olufemi Oladapo of the WHO’s reproductive health department said that more and more interventions have been given to women unnecessarily over the past 20 years, especially C-sections and oxytocin, a drug given to speed up labor. In the U.K., for example, C-section rates have grown from 10 percent of all births 30 years ago to today’s rate of 26 percent. The global average is 18 percent, and the WHO says that while some C-sections are always going to be medically necessary, the figures shouldn’t exceed 15 percent in any country.
According to Dr. Oladapo, childbirth is “not a one-size fits all kind of thing” and childbirth can take a lot longer than conventional wisdom suggests without the woman or her baby being in any danger.
The WHO has suggested that a better threshold for new mothers would be 5 centimeters of dilation in the first 12 hours; this would shorten to 10 hours in women who have previously given birth.
It’s important to keep in mind that the WHO is concerned about unnecessary C-sections. There are some legitimate medical reasons a woman might end up needing one, and it could save her life as well as that of her child.
In other cases, however, C-sections are simply a matter of convenience. The WHO suggests they are being performed when labor isn’t progressing as much as doctors would like. After all, they have other things to do and other patients to see. If they can wrap up a slow labor by putting a woman under the knife, not only can they charge a lot more money for it, but they can also move on to the next paying patient a lot quicker. This increased turnover, combined with the higher costs of C-sections compared to vaginal births, is good business from their point of view.
In other cases, the C-sections are being scheduled from the outset without waiting to see if the woman will labor normally or not. Doctors find it far more convenient to schedule a C-section for 10 in the morning on a weekday than to risk getting called in to a long labor in the middle of the night on the weekend. Sometimes they are even scheduled to accommodate a doctor’s vacation schedule.
There’s also an increase in women requesting the procedure. Some are worried about perineal tearing, and in some cases, it’s their husbands who are pushing for it because they think a vaginal birth might negatively impact their sex life.
Despite the convenience factor and the greater degree of predictability, C-sections, like all operations, do come with risks. They also place mothers at a higher risk of deep vein thrombosis and pulmonary embolism; uterine rupture can also occur in subsequent pregnancies. In addition, it carries a higher risk of respiratory problems for babies.
Nature is unpredictable, and that’s just part of life. Midwifery Professor Soo Downe points out that labor and birth have evolved over the years to ensure human survival, and giving birth naturally typically results in happy and healthy mothers and babies.
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