are now more involved than ever, sharing and bonding with their baby from the very beginning. Modern birthing also reflects a trend back towards an occasion of familial celebration rather than one of prudish exclusion.
Only a few decades ago it was a very exclusive and impersonal hospital system which had no tolerance for input from non-professionals. However these days, things have swung to what some might call the opposite extreme, where anyone and everyone gets to come along to the birth, and the event may even be videoed for those who couldn’t make it to the occasion, or for the baby’s video scrapbook and personal website presentation! But birth supporters, rather than being just spectators, should be there to care for and encourage the woman to have an easeful, beautifully memorable event. Anyone who can’t actually help support the labouring woman in what she needs, and who doesn’t help the vibe of the occasion with relaxation and understanding, is better off not being there. Ultimately, the labouring woman should always have the right to choose or change who is present during her birthing experience as it proceeds.
Supporters need to provide emotional support for the woman, who (in a hospital situation) finds herself in an alien environment, with people she does not know. Ideally a labouring woman should have a special bond with each person present whilst she gives birth. Many women have a great need for privacy during childbirth at the same time as needing company for alleviation of fear and upliftment of the spirit. Practically, any support companion must know when to attend to the woman’s needs – help her stand or move around, offer water, do some massage, change towels, help her to keep calm, and so on – and when to back off. Good support affords the mother the right mood and space so that she can focus on what she needs to do within herself.
An obstetrician is the medical system’s most highly trained birthing expert. They are surgeons skilled in managing the most difficult and life threatening kinds of births. They are the ones who can manage to deliver a baby from out of your abdomen rather than the normal arrange-ment through the vagina! Some are employed within the public health system and some are in private practice, where privately insured women
can opt to employ their services along with paying what is called a “gap fee” over and above what their premium covers. For those in public health attending a general labour ward, there is no option – you only get what you need, be it a midwife, junior doctor, general physician (rural hospitals only), the registrar (obstetrician-in-training), or the on-call obstetrician.
There are many women today who, the moment they discover they are pregnant, engage a private obstetrician. For some of these it may stem from a known or suspected medical need. For others it is considered the “safe thing”, a part of their private health insurance package and stems from a belief that public health care is not as safe (untrue) or comfortable (perhaps) as private health care. For others it is a way of indicating status or just the “done thing” by their peers. And beyond these two groups is the growing number of women who, having no need at all for an obstetrician’s specialist skills, opt for the elective caesarean without even wanting to know if they could give birth vaginally.
Just as there currently exists a massive overuse of hospitals for those who are not critically ill, I think there is an obvious over-servicing of obstetric expertise at present. I believe that women should only give obstetricians the deliveries they are trained for and not the healthy ones where they are not needed. Surely this would lead to greater job satisfaction for the surgeons; cheaper and less medicalised labours for women; and an enormous saving of funds for government – i.e. the taxpayer.
Within the hospital birthing system there are different layers of medical expertise and hierarchy. According to the system, responsibility is ranked from students (midwifery and medical); midwives; RMO (resident medical officer, ie junior doctors or the hospital GP’s); obstetric registrar (senior RMO, i.e. obstetrician in training); on-call or private obstetricians. This can cause all sorts of confusion for the labouring woman and can frequently lead to an escalation in the medicalisation of birth.
Even if a woman has engaged a private obste-trician she will still spend most of her labour in the care of midwives. Obviously a professional surgeon does not want nor need to be there whilst you dilate for 4 - 24 hours, or to turn up after a perfectly normal birth with no need for their expertise. But because they are your chosen overseer of the event, if there is even the smallest sign of complication they must be consulted and will probably be called to the scene. Upon this arrival, the event may then spiral into a series of