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Monday 12 July 2010

As published on The Punch, 14 July, 2010.

The 'right' way to give birth

Okay, so this is a delicate topic. How a woman ‘should’ give birth is such an emotion-charged issue because it’s something a woman has imagined since the moment she found out where babies come from.

If I am brutally honest, there are two camps of women here: one group of very vocal women who are yet to give birth, who are probably pregnant and have a very detailed birth plan (right down to scented candles and essentials oils). The other (far more realistic) group of women are the ones who know that a birth plan gets shot to shit when it’s crunch time.

And by crunch time, I mean that pivotal moment when you scream, “Please get this baby out of my body immediately, or I will kill someone.” (Not that I said this. In fact, I am surprised that for someone who likes profanities, I didn’t call my husband any names or tell him it was ‘his fault’. And whatever else Hollywood makes you believe is ‘normal’ during an intense delivery).

The first I’d heard of a birth plan was when I was pregnant. I’d always (naïvely) assumed the doctor would be the one making that decision. Turns out, I wasn’t so naïve after all. More on that later.

The issue on ‘how to give birth’ hit the news again a few days ago when it was reported that Dannii Minogue’s carefully scripted birth plan, the one she’d written on scented, embossed paper (I don’t know if this is true… but you can’t imagine ‘the plan’ on a yellow Post-It, right?) which included a home birth, was promptly turfed and she was ‘rushed to hospital’, undergoing an emergency caesarean instead.

Now. Let’s be clear, here. The very fact you are pregnant is a miracle in itself (something you only really appreciate when you start wanting a family). Then, the joy of having healthy babies is one surpassed by nothing else in life (again, only relevant if having kids is something important in your world). So how to give birth should be a no-brainer. Everyone wants the same end result: a healthy baby and a healthy mother. Because we have options to go natural (vaginal birth, no drugs), natural but with drugs (epidural, gas, etc), caesarean, or a home birth means that women not only have myriad choices, it also makes choosing one that much harder. The key here is to acknowledge that often the choice is taken out of your hands.

Have you seen the movie Knocked Up, when Katherine Heigl’s character is giving birth? No, not that scene when the baby’s head is crowning. Before that, when she’s in the throes of excruciating pain and demands an epidural. Trouble is, it’s too far along in the delivery for it to be administered and she has to push ahead (ahem) sans drugs. The funny-but-not-funny part is that she had a well-scripted birth plan, even kicking off the process with a relaxing bath. But as anyone who has given birth will tell you, when you get to the business end of birth, there is nothing Zen-like about it.

I have spoken with lots of women who have given birth, both for my parenting magazine stories and in conversation with my friends (when we are brave enough – and bevvied enough - to go there) and anecdotally what I have found is that women who have undergone an emergency caesarean feel a bit ripped off. As you would. For most women, the pinnacle of childbirth is going the natural route. For the truly heroic, the zenith is pushing out that child without drugs of any sort. But no-one’s plan is: push like a maniac for hours, then go under the knife anyway, and feel that all your efforts were for ‘nothing’. In reality, these women are champions; they should take a bloody bow. The truth is they brought a healthy child into the world; how they did it is no measure of how ‘womanly’ they are.

There are of course women who go the elective caesarean route; unfairly dubbed the ‘too posh to push’ brigade, these are the women who don’t want a caesarean as the last resort; it’s their first choice.

According to the 2005 National Perinatal Statistics Unit Mothers and Babies Report 30.3 per cent of Australian women gave birth by caesarean section compared with 19.5 per cent in 1995.

When I interview Dr Andrew Pesce on the topic – he is an obstetrician and gynaecologist as well as the Australian Medical Association President, plus Chairman for both the National Association of Specialist Obstetricians and Gynaecologists and the National Pregnancy Counselling Expert Advisory Committee – he said that the rise in caesarean births could be attributed to the fact that obstetricians are more likely to recommend a c-section because of the procedure’s improved safety. He also attributes it to more women believing a c-section is a more ‘desirable’ procedure over a vaginal birth. And then there is the litigation factor.

“When obstetricians are sued for a poor outcome, it is almost always for not having performed a caesarean section.”

He also cites a move away from more difficult forceps deliveries as well as a rise in older and obese women giving birth, pointing towards a c-section as a safer option for them.

Accompanying the story on the mini-Minogue birth were figures from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists which indicated that up to half of all first-time mothers attempting a home birth had to be transferred to hospital due to complications.

While I completely respect a woman’s choice to have a natural, non-interventionist birth, there are options available which reduce the risks associated with giving birth at home - birthing centres led by midwives attached to hospitals are an excellent solution.

As for me? Well, my birthing choices were extremely limited because I was carrying twins. My obstetrician was actually the aforementioned, wonderfully fantastic Dr Pesce (most women are ‘in love’ with their obstetricians. Ask them). He told me I had to have an epidural (there is likely to be manual manipulation prior to the delivery of twin number two) but he wanted me to give a ‘natural’ birth a red hot go. In the end, the pain relief made it possible for me to concentrate on pushing and deliver two healthy babies, 18 minutes apart. Hands down, the most empowering thing I have ever done in my life.

The key? Be very open to things not going to plan on your baby’s birth day. In fact, expect it.


  1. To be in control of the unknown (especially for the birth of your first child) by having a birth plan makes you feel good, yes? But as you say Josie, expect the unexpected. In the end I really don't believe it matters which way you give birth as long as the child is safe and in good hands. Yes I went through 16 hours of labour to then have an emergency caesar and I can tell you from my heart I was actually glad that it was all in the hands of the professionals. I cringe when women say that they lucked out by having a caesar - really does it matter?

  2. My first child was 6 hours in labour with pain relief. My second child came all too quick, no drugs and a home birth. No drugs was ok , however home birth i would not recommend to anyone as it was scary and the mess.....