can hold a woman back just at the time when she most needs to be open and allow her baby out. Most midwives and doctors are acutely aware of this perception and will only use episiotomy in cases of real need.
Also called Active Management of the 3rd Stage and Accelerated Placental Delivery, in hospitals it is standard practise to administer an injection of the synthetic hormone syntocin (syntocinon) into the mother’s thigh immediately after the birth of her baby. This drug increases the speed and strength of the contractions of the uterus, accelerating separation of the placenta from the uterus wall.
Historically, several reasons have been given for this methodology: (i) that it reduces the risk of haemorrhaging, (ii) that it reduces afterpains, (iii) that it saves time and reduces inconvenience for the woman. But whilst it unarguably takes less time, usually 3 - 5 minutes, many women have found, myself included, that the afterpains, bleeding and degree of retained membranes are all increased with induced placental delivery. After each of my 3 hospital deliveries, I was given syntocin as a matter of course. Like most women, in those days I figured that once the baby was out, it didn’t matter how the placenta was delivered. They each took around 3 minutes to arrive, and yet: on the first occasion I experienced severe haemorrhage and clots; on the second occasion I had retained membranes, clots plus I had painful uterine contractions for 24 hours after delivery, especially when breastfeeding; on the third occasion, I had even stronger afterpains for 24 hours; after all these births, I bled moderately to heavily for at least 7 days. However, when I had my last 3 babies at home, syntocin was never an option, and even though each placenta took an hour or slightly more to deliver, I experienced no excessive blood loss either at the time or in the few days following. I was pleasantly surprised at how little I did bleed, thinking that 7 days of heavy bleeding was normal. After just 2 days, bleeding had reduced considerably to a brownish discharge, and I did not experience any afterpains following any of those 3 homebirths! So much for the great benefits of syntocin.
This intervention, like many, is part of a concept called “expectant or active management” because it is expected there will be a problem! Due to a
perceived risk,the medical solution is to act before the event 100% of the time, rather than to act appropriately in the event of the small percentage who do require assistance. It is done, they like to tell us, “to help speed things up and to minimise blood loss”. But you have to wonder how nature has been able to deliver placentas for millions of years without such “help”, how women have survived such a boring ordeal as a one hour wait, and how we have not become an extinct species due to post-partum haemorrhag-ing.
Caesarean section is unarguably a major surgical procedure which has inherent risks, both for mother and baby, although strangely, many people outside of the medical fraternity believe it to be “safer” than vaginal birth – which it certainly is not. Unfortunately, due to the rising incidence of caesareans today, a mother-to-be should inform herself about the caesarean procedure and all its risks in case she finds herself in the position of having to make decisions about it.
The operation is done either under general anaesthetic, or an epidural which desensitises the patient from the waist down. The delivery of the baby is quite quick but the suturing of the wound is complicated and takes some time. During the first few days you are strictly limited to bed and recovery will be quite painful. This can inhibit a woman’s ability to interact with her baby. Healing afterwards is dependent on one’s general health, but normally takes several weeks with many restrictions on bending, carrying, lifting, driving etc.
As with any intervention procedure, the mother can feel secondary to the “outcome”, far removed from the process and a failure in terms of her hopes and plans for the birth. These emotions all influence the way she sees herself in her new role as a mother and particularly how she approaches any future pregnancies and labours.
Caesarean delivery used to be considered a rare and last resort method which came at the end of a gruelling labour that was failing to progress and threatened the life of the mother or the baby. 40 years ago the figure was 5%. However these days, the caesarean rate has risen enormously to an average of 25% of births nationally, ranging from 15 - 50% in particular regions, and variation with hospitals and level of health