THE RECENT concern about changes to medical insurance arrangements has been revealing.
Most worrying was the apparently widespread fear in pregnant women for their unborn infants and themselves, that terrible things would certainly happen if an obstetrician did not attend them. How realistic is the fear that women have about the safety of childbirth?
Sharing stories of childbirth and problems with newborns is almost the stuff of a kind of secret women's business.
Listening to these stories that are emotion laden with frequent incorrect information can create a sense of dread in young women facing the most momentous event of their lives.
Thank goodness for well trained and compassionate health professionals who can provide sound information and impartial opinions to help women make sense of what they have heard from friends and relatives, and then to make suitable choices for themselves.
But at the core of the issue of childbirth is the fact that it is a natural process, not one that is designed to kill the mother and harm the infant.
If this were the case we would all have died out long ago. The actual normal experience can vary from a short mild episode lasting only minutes or a few hours, while some last for many hours with considerable discomfort and awkwardness.
For the baby, a vaginal birth is designed to be physiologically the most appropriate method for making a transition to independent life.
Variations from that method are less than optimal and not to be chosen lightly. This includes choosing epidural anaesthesia that has been reported to double the likelihood of a consequent caesarian section and quadruple the risk of a forceps delivery.
It is only the infrequent, very difficult, births that require substantial surgical intervention like a caesarian section for example. So infrequent that the World Health Organisation indicated rate is around 10 to 15 per cent of all births.
This is in stark contrast to what pregnant mothers experience in reality.
In privately insured women the rates have been quoted as high as 25 to 30 per cent while in public patients the rate drops to 13 to 19 per cent.
Some reports have even suggested that as the number of obstetricians rises so does the caesarian rate with one well resourced South Australian hospital in 1999 apparently having a rate of 50 per cent!
There are similar contrasts in episiotomy rates (the cut in the perineum to enlarge the vaginal opening) though the majority of first-time mothers will have this procedure.
One excellent study in the US found that routine use of episiotomies for first-time mothers was inappropriate though almost half of the doctors sampled used episiotomies on 90 per cent of their first-time mums!
Oddly these outcomes are contrary to what even common sense would say should be happening.
It is the privately insured that have access to better nutrition, education, housing, and sanitation and frequent and ante-natal and birthing care from obstetricians that should have the least problems and surgical interventions.
Public patients are by contrast more likely to have fewer economic resources and less frequent ante-natal screening.
Midwives usually attend them when going into hospital to have their baby.
Fortunately for them, research consistently finds that in low risk births (normal length of pregnancy, single baby, good general health of mother, etc) outcomes for midwife-attended women show lower episiotomy rates, lower infant deaths, and higher birth weight.