Trends in childbirth

From rising rates of intervention and gestational diabetes, to better-informed and discerning mothers-to-be than ever before, obstetrician Rahul Sen talks about how medical and technological advances and trends in demographics are changing childbirth.

Based at both the Prince of Wales Private Hospital and the Royal Hospital for Women, where he runs the diabetic obstetric clinic with Dr Sandra Lowe, Dr Sen specialises in high-risk pregnancies, particularly the five to eight per cent of pregnant women affected by gestational diabetes.

The rise in diabetes and big babies

“Along with the rest of the developed world, Australia has seen a significant rise in type 2 and gestational diabetes, which used to be fairly uncommon,” says Dr Sen. “This is due to our increasingly sedentary lifestyles and high fat, high sugar diets.”

Data collected from midwives and published in annual Mothers And Babies reports shows that the percentage of babies in NSW born heavier than four kilograms rose from 10.9 per cent in 1990 to 12.1 per cent in 2005. Bigger babies are often the result of gestational diabetes which, in turn, is frequently caused by maternal obesity.

Bigger babies increase the risk of complications in delivery, the need for caesarean sections, and damage to the pelvic floor which may result in prolapse and incontinence later in life. Large babies are at greater risk of metabolic disease such as diabetes, hypertension and fatty liver disease.

Women with gestational diabetes have a high risk of it recurring in subsequent pregnancies. As Dr Sen explains, pregnancy puts the body in a slightly diabetic state. “Pregnant women would do well to follow a low glycaemia-index, diabetic-type diet, replacing fats and simple carbohydrates, such as sugar, white bread and white rice, with more protein and complex carbohydrates,” advises Dr Sen.

Screening for and treating gestational diabetes results in much better outcomes for mothers and their babies, according to the 2005 Australian Carbohydrate Intolerance Study in Pregnant Women.

Increased medical intervention in childbirth

Medical interventions, including the use of anaesthetics, episiotomies, induced labour, elective caesarean deliveries, and medically-assisted conception, have accompanied falls in infant and maternal mortality rates in developed countries.

As Dr Sen explains, “Even in the last 20 years, we are in a different climate medically and expectations-wise. Technological and medical advances and the rise of the internet in particular has lead to a slightly older, better-informed, more discerning and demanding population of women who want either more or less intervention.

“There is less acceptance of imperfect outcomes, whatever these may be, so we do a lot more things that we might not have done in the past just to ‘be sure’. Expectations are very high and rightly so – this country has an excellent health system and standard of health – as long as they are realistic.”

But, as Dr Sen explains, there is a need to strike a balance. If a concern is raised during birth, parents need to capitalise on advances in medicine to avoid introducing unnecessary risks. This requires discussion of the various possibilities and their accompanying levels of risk between the parents-to-be and their medical team, which highlights the importance of this relationship.

The rise in women over 35 and 40 having children for the first time has heightened medical advances in the many risks that these often involve, including multi-pregnancy, pre-eclampsia, miscarriage, and stillbirth. Older mothers need increased surveillance during pregnancy and may need to plan an earlier delivery if there is a risk of the baby being stillborn.

“One of the joys of modern technology is its application to extend a woman’s fertile period,” says Dr Sen. “I cover the various issues and respond to them appropriately.

“I try to match women’s expectations with what is realistic. Life isn’t simple or predictable and this particularly applies to babies, both inside and outside the womb,” says Dr Sen. “I work very closely with women, their midwives and support people to try to make anticipation of the delivery less fearful and more optimistic.

“A birth is successful if the mother and baby are healthy and the mother is happy with her experience, and this has a lot to do with expectations.”

How to improve the chance of fertility and natural delivery

Regular, small amount of exercise can dramatically improve fertility. Diet is an often overlooked area. “On occasion, I work with a herbalist or nutritionalist for couples who have had problems with fertility, which has a good impact on general health and wellbeing,” says Dr Sen.

The effect of stress and pressure on fertility cannot be underestimated. “Couples who can learn to relax tend to conceive easier and cope better with the ups and downs of pregnancy.”

Dr Sen also recommends pre-natal classes that emphasise the positive and empowering aspects of birth – an area often overlooked in hospital-run courses which focus more on ‘coping’ with pain and discomfort.

“Along with most obstetricians, I aim to deliver the baby safely with as little intervention as possible because one intervention often provokes a spiral of further interventions which lead to health complications and lengthen the post-partum recovery period,” says Dr Sen.

“I focus on protecting the perineum and sphincter during pregnancy and delivery to help minimise short- and long-term damage and aid post-partum recovery.”
 
Supporting women after birth

The post-partum period is often the most difficult due to lack of adequate care. Women who have unexpectedly complicated births are at heightened risk of developing post-natal depression.

“We don’t tend to see a lot of problems, both emotional and physical, that women are experiencing at home,” says Dr Sen. “These include ‘baby blues’, not severe enough to be diagnosed and treated as post-natal depression, and the many physical and emotional repercussions of sleep-deprivation. Added to this is a lack of breastfeeding support, education and advice which may lead to babies being bottle-fed earlier than ideal.”

To this end, Dr Sen in conjunction with a midwife, is establishing a post-natal service of home visits. “The downside of being an older, more educated population is that we are more isolated,” notes Dr Sen.

“Oftentimes depression and other health issues can be alleviated simply by giving the new mother a break from baby. An extended family network to provide reassurance and support makes all the difference in helping women recover quickly from birth.”

Dr Sen was Lynn and John de Voy’s obstetrician for the recent birth of their twins and is one of our clinic's support practitioners. Visit Dr Sen's website. 

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