IN CONTROL: Erkal-Paler was denied an elective C-sect ion but has written up a detailed birth plan
Posted Sunday, March 7, 2004; 14.48GMT
Of the 90,000 Dutch women who gave birth with a doctor present in 2002, 27% received pain relief — up from 21% in 1995. But the pain, says Kruit, "is meant to be there. It tells you and your baby to go further or to stop." Not everybody is so sanguine. "It's like a religion," says author Heleen van Royen, whose best-selling novel The Happy Housewife tells the story of a woman driven insane by the agony of childbirth. "The midwives say the pain is good for bonding with your child. It's medieval."
In Italy, too, maternity services still tend to see suffering as part of childbirth. In 2001, only a quarter of Italian women were allowed to choose their birthing position. And although 50% of Italian women ask for pain relief, only 10% get any in the public hospital system. To compound the problem, the system suffers from a shortage of some 1,500 anesthesiologists. No wonder one in three Italians is now born under private insurance cover. Monica Mercuri, 39, gave birth to her first child in 2002. In her second month of pregnancy, she went to see a private gynecologist in a public hospital. She was told two things — that her pelvic area might be too small for her to deliver her baby, and that her doctor could not schedule a C-section unless the labor was prolonged or at risk. This was too much to bear. "The hypothesis of suffering like a dog for 10 hours only to finish by having a caesarean was too much," she says. She found a surgeon who assured her of a C-section by appointment. The fee: €6,000.
Her doctor may have had his own reason to offer the procedure — it decreases his chances of being sued. In Italy, litigation against obstetricians has soared; in 2002, there were about 8,000 lawsuits against obstetricians, accounting for about half of all medical lawsuits in that year, and a 1,600% rise over the number in 1987. Of greater concern: malpractice in Italy is not only a civil offense, but also a criminal one. Says Claudio Giorlandino, president of Italy's National Commission on Maternity and Birth: "The huge majority of legal suits regard litigation about caesareans that perhaps should have been done. They are never about an excess of medical treatment."
Nowhere is the baby battle more heated than over the question of C-sections. The numbers continue to rise: in Italy, the C-section rate stands at a sky-high 32.9%, up from 21% at the beginning of the 1990s. In Germany in 1991, 15.3% of babies were delivered by C-section; by 2001, the rate had risen to 22.6%. That's well above the 15% ceiling recommended by the WHO, although some physicians insist the who figure is hopelessly outdated. Critics of C-sections see them as unnecessary surgery. "There is such thoughtlessness about the way a C-section is being sold," says Elisabeth Geisel, German coordinator of the European Network of Childbirth Associations. "C-sections have a huge impact on a woman's body and are simply not the way nature has planned birth," she says.
Adding to the controversy is the trend among some higher-income women to choose C-sections out of convenience or to avoid the pain of a vaginal delivery. Around the late 1990s, medical literature started to feature essays on the ethics of C-sections-on-demand — known as "maternal choice" or "maternal request." Soon the popular press was filled with images of yuppie women slotting C-sections to fit in with their schedule-obsessed careers, or out of sheer vanity. Liz Hurley and Victoria "Posh" Beckham are among the celebrities who have had elective C-sections, although Beckham says hers was for medical reasons.
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