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Commentary: The changing nature of birth

Thoughts on the changing nature of human births.
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Planned C-sections for convenience, rather than safety, raises ethical questions, says columnist. Photo submitted.

We said goodbye to a beloved 17-year-old dog this week. She had rapidly lost quality of life. As sad as it was, few would have any qualms whatsoever with the vet’s provision of humane, painless, and sensible euthanasia. But what’s going on with medical interventions at the great miracle of birth?

It’s no secret humans commonly push the boundaries of scientific possibility – for better or for worse. Traditionally, interruptions in the natural birthing process have been overwhelmingly in the “for better” category.

Caesarean sections may not have been a desirable option for women prior to the advent of modern surgical techniques – uterine suturing, for example – not to mention anaesthesia. But in the modern era, there can be no doubt that for countless millions of mothers and babies, the C-section has saved their lives.

What’s questionable now are the projections. And concerns about C-sections are just the start.

A report in the British Medical Journal Global Health states, “by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans annually).” That figure ranges wildly from place to place, with rates as low as 7.1% in sub-Saharan Africa and as high as 63.4% in Eastern Asia.

In some parts of Africa rates are skyrocketing. For instance, between 2017 and 2020, data on payouts made to Kenyan hospitals as compensation for birth-related services showed an almost 10,000% increase for C-sections.

The safety of mother and child is the right rationale for decision making. A Caesarean might be planned to mitigate problem pregnancies, or become an urgent procedure if labour is not progressing and mother or baby is in distress.

A natural birth is the better option for healthy pregnancies. The risks of heavier bleeding, infection, blood clots, surgical errors, and higher complication rates for future pregnancies are part of the story. Slower recovery times after C-sections combine with delays in establishing breastfeeding and skin-to-skin contact too.

The benefits of “kangaroo care” to the newborn include greater respiratory, temperature, and glucose stability, as well as decreased stress. Mothers and fathers who hold their newborns skin to skin after birth have increased parental attachment, more confidence in caring for their babies and longer breastfeeding duration.

Yet, with one in four births now being C-sections, there is mounting evidence the medical rational is being overtaken by a convenience factor. Some doctors report being pressured by patients for C-sections for unjustified reasons – for example, to plan the day of the birth to coincide with a relative's birthday or to avoid a holiday. Some patients give in to the convenience of a doctor's schedule.

But these issues are child’s play compared to those at the forefront of scientific advances involving birth. Artificial wombs are in development. A study published in Nature Communications in 2017 demonstrated the use of a liquid-filled, plastic apparatus allowing premature lambs an additional four weeks of growth in a simulated womb.

It is only a matter of time. The definition of ectogenesis, the development of an embryo in an artificial environment, used to include the caveat “chiefly in science fiction”. But artificial wombs are a rapidly advancing technology that will change the nature of mammalian reproduction, we humans included.

Parents wondering about the future employment prospects of their children might want to direct them to the study of ethics. We still have time to think this through and put in place a set of rules. 

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