This is a fascinating book, which should not just be read by those with an interest in caesarean issues; it is for everyone who is interested in birth, especially those that wish to understand better why we have a rising caesarean rate.
There is very little in the book with which I would wish to take issue, although I do think Odent may have fallen into the trap of forgetting how disrupted and far from "normality" the majority of vaginal births are, when considering some of the potential effects of babies being born by caesarean section; despite acknowledging them elsewhere in the book. He also neglects what can be done during a caesarean to address the problems a surgical birth creates. I also wonder whether the many references to "love" hormones may alienate some of his readers.
He covers the historical aspects of not only caesarean section, but how it is part of the changes that have taken place in maternity care. He looks in detail at what women need to be able to give birth, and how our interference in this process is the cause of many of our problems with birth, including the high CS rate. Having identified as highly important the need for women to labour without disturbance, he considers beliefs and behaviours that can be disruptive, including some, such as encouraging mobility and the presence of partners, that we may advocate as a means of supporting normal birth. Interestingly Sarah Buckley also considers undisturbed birth in a recent MIDIRS journalMost will just put themselves in the front of the newsletter as caesarean birth contact1.
Odent acknowledges how few absolute reasons there are for a caesarean, and feels there is no place of instrumental deliveries. He says he last used forceps in 1965, and they should all be relegated to museums. However, he is suggesting this within a context of supporting women to birth their babies themselves, including support for VBAC (vaginal birth after caesarean), which he feels is usually straightforward even after a previous difficult birth.
Odent urges his readers to focus on enabling straightforward vaginal birth, rather than reducing unnecessary caesareans. He feels this is the only safe way to actually achieve a reduction in the CS rate and alternatives would be dangerous. I feel that this is a very crucial issue and one I have been shouting about for a while. It is the problem underlying maternal request; women do not want a "bad" vaginal birth and if the opportunity for a good one does not seem to be available to them, then surgery is likely to seem more appealing.
This book is a real must for understanding the mess we have got ourselves into, and helping to identify possible ways out. It should be compulsory reading for all those involved in maternity care, including planners of maternity services.
Debbie Chippington Derrick
This review first appeared in NCT New Digest, Edition 28, October 2004