Australia has one of the highest c-section rates in the world. A decade ago the rate was under 20%; today the number of births ending in major surgery has reached a huge 32%.
This is despite the World Health Organization’s recommendation that c-section rates should be around 10-15%, and should only be performed when medically necessary.
Above this rate, there is no evidence of improved outcomes for mothers and babies. In fact, the surgery exposes them to increased risks of complications and injuries.
So, if increasing rates of c-section don’t improve outcomes, why are more than one-third of Australian women now giving birth via surgery?
TRUTH: The Maternity Care Model Matters
Many birth educators, midwives, and even some obstetricians, believe the increasing rate of unnecessary c-sections is being driven by Australia’s medically focused maternity system.
In countries where midwifery-led models of care are the norm, c-section rates are low, or within the recommendations of WHO.
Midwifery is one of the oldest professions in the world. Midwifery-led models of care focus on pregnancy and birth as normal events, which only involve medical care if the need arises. Healthy, low-risk women who access midwifery care are more likely to achieve a normal vaginal birth with minimal intervention.
Europe’s largest study of childbirth and maternal care, the Euro-Peristat 2010 report, showed wide differences between c-section rates – ranging from 14.8% in Iceland to 52.2% in Cyprus.
Nordic countries have c-section rates in line with the WHO recommendation of 10-15%. They also have low mortality rates for mothers and babies. In their maternity systems, midwives provide the majority of the care. Obstetricians are involved only if there are complications.
Professor Hannah Dahlen, spokesperson for the Australian College of Midwives, believes Australia could learn from these countries where c-section rates are low.
“When we look at the countries in the world that have both low caesarean section rates and excellent outcomes for mothers and babies we find three things in place: firstly, midwives are the cornerstone of care, and obstetricians are only involved where there are complications; secondly, evidence based care is actually taken seriously; and thirdly, there are strong social policies supporting parenting in place. We could improve in all three areas in Australia”.
TRUTH: The Birth Place Matters
In Australia, most women give birth in a hospital setting. Some hospitals offer midwifery programs, but the places are limited.
Women giving birth in hospital are likely to be supported by midwives, but will come up against hospital policies that increase the risk of interventions during labour. These might include induction for being ‘overdue’, and time limits on labour.
In private hospitals, where obstetricians manage care, the c-section rate is double the rate in the public hospital system.
In 2011, 43% of women in private hospitals gave birth by c-section, compared with 30% in public hospitals.
Obstetric medicine specialises in dealing with health problems in pregnancy. Healthy, low-risk women are at increased risk of interventions and c-section when cared for by an obstetrician.
TRUTH: There Are Limited Choices For Birth Options
Every woman wants a birth which is safe for her and for her baby. When women are planning the type of birth they want, including any births they will have in the future, other important factors are their own wellbeing, and their recovery following birth.
Yet many women feel they are given little choice about their options when giving birth in hospitals settings today.
Often women feel pressured, or coerced, into procedures that are not necessarily evidence based, but exist because of hospital policy.
Very often, when women talk about their emergency c-sections, the cascade of interventions is evident in their stories.
They might have their labour induced, because hospital policy dictates ‘overdue’ as being 10 days post due date. This leads to having an epidural, due to the intense contractions and continuous monitoring of how the baby is coping. There might be fetal distress, or failure to progress, and the inevitable outcome is then an emergency c-section.
Many obstetricians argue the rising age and greater weight of birthing women are the causes of increasing rates of c-sections. Women who are older (over 40) or obese (with a body mass index of 30+) are more likely to be treated as high risk, simply because they are in a higher risk category for pregnancy complications, which predispose them to a c-section. While this partly explains the rise in caesarean section rates, studies have shown it does not explain the majority of the rise.
TRUTH: C-sections Have Short and Long Term Risks
Without doubt, c-section birth can be life-saving in medical emergencies. But the risks need to be weighed carefully against the benefits. C-section has many associated risks, including increased risk of infection, extended stay in intensive care, loss of uterus (hysterectomy), haemorrhage, or death.
Many of these risks, and the likelihood of experiencing them, are greatly increased with the number of c-sections a woman has. This includes the risk of serious conditions such as placenta accreta.
During c-sections, babies can be cut, and they are more likely to experience respiratory distress and be admitted to neonatal intensive care units.
Long-term risks include interfering with the establishment of breastfeeding, potential effects on the baby’s gut and future health, and the increased risk of life-threatening complications for the mother in any future pregnancies.
TRUTH: Normalising C-sections Influences Choices
As c-section rates rise, so does our acceptance of c-section as a normal birth outcome, instead of major surgery that should be avoided unless absolutely medically necessary. Women aren’t encouraged to think of birth as natural, or as a process that can go smoothly. They are less informed about the many procedures they are likely to encounter in hospital, leading to c-section.
While women should have the right to choose a c-section, it goes without saying this decision shouldn’t be made lightly. They should have a full awareness of the short and long term risks. How common c-sections are today directly influences how women view birth. C-sections are often seen as safe and relatively straightforward, compared with the ‘unpredictability’ of normal labour and birth.
It is precisely this fear of normal birth, experienced by women and their care providers, that is helping to drive c-section rates up. Instead of allowing more than 200 Australian women a day to have unnecessary and risky surgery, all healthy, the system should provide low risk women with access to primary midwifery care through pregnancy and birth. This would make sure women who need specialist pregnancy and birth care received it, and those women who don’t would not automatically be at risk of interventions that could lead to an unnecessary c-section.