Dr Luka Velemir, gynecologist-obstetrician in Nice : "Women should have the right to choose to give birth by caesarean section."

"Today, cesarean section is considered, rightly, as a failure of vaginal delivery, which is considered normality.The problem is that we therefore tend to neglect the human side Cesarean delivery, but also to make women feel guilty, and I would like patients to benefit from the same care and support.

The second is not to demonize women who opt for this method of delivery. Among my patients, those who choose caesareans have various reasons: the fear of giving birth vaginally, a fear of episiotomy , damage to the perineum and prolapse later, or that this has repercussions. about his sexuality. They may also have been touched or sexually assaulted, have a history of difficult childbirth with the use of forceps ... The idea is to launch the debate: why do not we give the means to the patients to live their delivery happily, whether by caesarean section or by natural means?

Towards a kind Caesarean section

Today, most cesarean sections are performed according to a very fast, effective technique, which gives almost correct results, and which is especially easy to teach interns. But this technique causes pain, nausea and even vomiting during childbirth. It is an evisceration and it is anti-physiological since to suture the uterus more easily, it came out of the womb. For example, this is what veterinarians do not want to complicate their life.

In a think tank of liberal gynecologists of which I am a part, we are therefore interested in how to improve the operative follow-up. We studied all the existing techniques, imported surgical elements that come from other specialties such as urology, vascular surgery and aesthetics to bring another way to operate: the extraperitoneal caesarean section of Fauck. It allows access to the uterus, which remains in its place, by an anatomical path less invasive and aggressive to the body. You just have to learn to find it.

Attention, we do not fight for everyone to practice, but it develops much more. Patients deserve it.

Cesarean birth plan, a choice and a right to claim

Those who wish should also be able to regain control of their body by having the right to choose to give birth by cesarean section. Because the idea that cesarean section is used only in cases of force majeure because the life of the baby is in danger is false and outdated. This was the case 40 years ago. The concern is that since very young women have said they will meet Prince Charming, get married, two children by natural and epidural ... It's a shame to stigmatize women in this way and many are unaware that they have the choice.

The gynecological and political authorities in France plebiscite the birth by natural way and type on the fingers of the doctors in the hospitals so that they lower their rate of caesarean section because they consider that it is not 'normal' and 'natural', it's just dogmatic. There is a pressure of the caesarean section rate that should not be increased in France.

Those who wish should also be able to regain control of their body by having the right to choose to give birth by caesarean section.

On the one hand, it's good because it's a crazy guard for extreme behavior that would lead to cesarean section for everyone, but on the other hand it's not because the patients are a little taken in hostage. There is no good reason to refuse a caesarean section to a patient who wants it. And it does not cost more, especially if you adopt the right techniques.

So there are messages to pass: the caesarean can be done in an innovative way with much less aggression. It is not dangerous, nor is a natural birth. Women can perfectly have the right to choose it, but also to be able to keep the father of the child by their side, to see their baby, to skin to skin, to have an anesthetic and post-operative protocol that allows to get up after two hours. Why are they punished under the pretext of medical safety? These women are monitored in the recovery room at the same time as patients who have just had a colonoscopy! They have nothing to do there!

Everything is decided within the high political authorities and learned societies, the next step is to talk to the National Union of Gynecologists and Obstetricians of France (SYNGOF), which is already working on a charter of benevolence for delivery by natural route . "

Marie-Hélène Lahaye * author of Childbirth: women deserve better (Michalon) : "One cesarienne out of two is already useless."

"There is good and bad in Dr. Velemir's proposal.

Even respectful, caesarean section remains a surgical operation. Today in France it represents 20% of deliveries. According to the World Health Organization, beyond 10%, there is no benefit to public health, in other words, one in two caesareans is useless. Even though it is described as 'benevolent', the generalized caesarean section goes against the recommendations of WHO. Rather than trying to trivialize cesarean section, the most important thing is to limit it to situations that really require it.

Today, when we look at how parturients are supported, we see that a whole series of medical procedures that aim to accelerate delivery - episiotomy, caesarean section of the uterus - are useless, and have a negative impact. on the course of delivery. But as soon as they are offered by a doctor, we do not ask questions, even if they do more than necessary. The society considers that the doctor is always right, even when his decisions are against the interests of the woman and her consent. On the other hand, when the demand comes from the women, it is a bit of the obstacle course to get it, as legitimate as it is. I think of this woman whose life is hell because of her endometriosis . She experiences excruciating pain every month. Since she does not want children, she asked for the removal of her uterus but found no doctor willing to do so.

Women are rarely respected

Certainly, women ask to schedule a caesarean section out of any obstetrical problem. This concerns 1 to 17% according to the studies of the requests for cesareans. It is a desire that can come from those who have suffered sexual violence and can not imagine giving birth vaginally. It is a very respectable request and it is justified that they can obtain it. There are also requests from women who believe that their body, their vagina after a vaginal delivery will be deformed, or who are afraid of pain , afraid of dying. Instead of doing caesareans, we must work on women's fears, reassure them, and transform their representations of childbirth.

When we talk to midwives, we realize that they have a much more positive vision of childbirth than doctors who tend to quickly medicalize delivery. 'Are you afraid, madam? Well, we're going to have a cesarean. '

But to offer a more sympathetic accompaniment of cesarean section, in itself, is good. Because it is true that women are rarely respected. They are tied arms in the cross, while sometimes the staff chatter of their holidays above the operative field. We do not take into account what they feel. If they complain of pain, they are told that it is not possible because they have an epidural, while we saw live caesareans. The father is removed, and they find themselves alone ... We must respect the women who give birth in empathy with them because a birth is a special moment.

Instead of doing caesareans, we have to work on women's fears, reassure them, and transform their representations of childbirth

Cesarean section pays 5000 euros to the clinic or the hospital against 3000 to 4000 euros for a traditional delivery. Caesarean section mobilizes more staff but in less time. So there is a tendency to do more caesareans in private clinics. The tendency to do more medical acts is not necessarily linked to financial reasons but to go faster. When women ask me where to give birth, I say, 'Not necessarily in a private clinic. You will not necessarily be better off giving birth. ' Among the women who denounce obstetric violence , there are some who have given birth in listed clinics, reputed. "

* Also author of the blog " Marie gives birth"