Article: Caesarean Sections Continue To Rise

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Caesarean sections continue to rise

The number of caesarean section births is continuing to rise, according to data presented in a new report released today by the Australian Institute of Health and Welfare (AIHW).

Professor Michael Chapman, Head of the School of Women's and Children's Health, UNSW, said that of all women who gave birth in 2003, the majority (60.3%) had a spontaneous vaginal birth, but that caesarean sections were still increasing.

The report, Australia's Mothers and Babies 2003, prepared by AIHW's National Perinatal Statistics Unit (NPSU), shows that in that year, 28.5% of mothers had a caesarean section delivery, compared with 19.4% in 1994.

Of caesarean sections in 2003, 57.9% were without labour (elective), while 41.9% were with labour (emergency).

'Caesarean section rates tend to be higher among older mothers and those admitted to private hospitals,' Professor Chapman said.

For women who gave birth in hospitals, 37.4% of those in private hospitals had a caesarean section compared with 25.7% of those in public hospitals.

Caesarean sections were less frequent among Aboriginal or Torres Strait Islander mothers; 23.3% of whom delivered by caesarean section, compared with 28.8% of other mothers.

Among mothers who had given birth previously, 23.1% had previously had a caesarean section. The majority of these mothers (81.4%) had another caesarean section in 2003.

Caesarean section deliveries were common for babies with breech presentations at birth. Of these babies, 87.3% were delivered by caesarean section.

Over the period 1994-2003, instrumental deliveries, including forceps and vacuum extraction deliveries, decreased from 11.7% to 10.7%.

In 2003, forceps deliveries occurred in 3.9% of mothers, while deliveries by vacuum extraction accounted for 6.8%.

There were 256,925 babies reported to the National Perinatal Data Collection, born to 252,584 mothers in 2003.

Of these mothers 8,857 were Indigenous, making up 3.6% of all women who gave birth in Australia in 2003.

'The average age of all mothers was 29.5 years, and for first-time mothers, 27.6 years, continuing the upward trend seen in maternal age in recent years,' Professor Chapman said.

While one in 25 mothers intended to give birth outside of a conventional labour-ward setting in 2003 (4.0%), only 2.8% of mothers actually did so, giving birth in places such as birth centres or at home.

Multiple pregnancies accounted for 1.7% of all pregnancies and included 4,179 twin pregnancies, 76 triplet pregnancies and four quadruplet pregnancies.

Canberra, 7 December 2005

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And this in another paper:

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Caesarean sections up 40 per cent
A new report on the birth of Australian children shows the rate of caesarean sections has increased nearly 40 per cent over the past decade.

The Australian Institute of Health and Welfare study shows that 23 per cent of Indigenous women now deliver by caesarean section compared to 28 per cent of non-Indigenous women.

Professor Michael Chapman from the University of New South Wales says the figures also show that an Indigenous baby is twice as likely to die before it is a month old.

"The other factor that comes into play is that girls in their teens also have a very high loss of babies either in late pregnancy or in the early neo-natal time and that may be a co-factor in why the Indigenous population do seem to be doing badly," he said.

He says increasing caesarean rates will put more pressure on hospitals, especially those in remote areas with relatively few resources.

Professor Chapman says the women who deliver by caesarean section are generally unable to have a natural birth again.

"Once you've had a caesarean section the implications for the next pregnancy is that if you have a vaginal delivery there is an increased risk both for the mother and for the baby in terms of complications," he said.

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Increased risk?! Haven't there been enough studies of late showing that there is a higher complication risk of a second caesar?! Argh, the world has gone mad LOL!

I sometimes wonder whether the professioanls actually read articles and speak to each other- thats why this site is GREAT!! you can get real world experiences.

There was a talkback segment on 3LO this morning about c/s birthing which was really interesting. It was started because of the high costs to the health system of un-necessary c/s and also misconceptions about it.

I'm not sure when the transcript will be up but as it was in the first 30 mins of the Jon Faine show you can listen to it online. The original report was by an OB but they also had comments from women who had had emergency c/s then vbac and elective c/s. They also had some midwives call and they debunked a lot of the myths... c/s is better for the pelvic floor muscles (?WT?)... it was really interesting. Just go to the ABC website and select radio then regional, vic, melbourne and you will be in the 3lo bit, then select the Jon Faine section and you can access the download for the program.

I have heard that a lot of mothers to be choose elective caesarian purely because they don't like the inconvenience of not knowing exactly when their baby will arrive. Is this really true?? I always thought that elective caesars were planned because of known risks or previous complications for that woman. Why on earth would anyone choose to have major abdominal surgery for no particular reason? Shouldn't doctors and obstetricians advise against this? Don't get me wrong, I have no argument with women who consider the options and decide that a caesar is going to be the safest/best choice for them and their babies. But I honestly think that anyone who simply can't stand the lack of control and unpredictability inherent in childbirth should be thinking twice about having a baby in the first place. Because kids are going to be unpredictable!

It's true that people do choose caesareans for reasons other than possible complications (and I have known many who have). The rate of intervention at private hospitals and in older women seems to me more indicative of the trend for this age group to minimise risk to the baby (as they see it) rather than as a convenience factor.

I have one friend who is planning on a caesar (if she does get pregnant) and she has many reasons. She will be close to 40 by the time it happens, she has a poor pelvic floor already and she is afraid of losing sexual pleasure. A number of her friends have through tearing. I don't really agree with her reasons, but she is a good enough friend that we can actually discuss it with her, so regardless of which way she choose to go at least she has talked about it.

Astrid

I had an emergency c/s and was completely(and still am)devastated that I had to have one.Unfortunetely its a complication that has been passed from my mum to my sister and myself that none of us are able to birth naturally(small pelvises that can only birth a 4lb baby or smaller).I really don't understand how you could just book yourself in for one because thats what you would prefer.It is like Angelfish has said MAJOR abdominal surgery and it does take a while to get back to normal and the scar does need maintaining throughout your life so it never gets infected etc.I was so upset because I couldn't even hold Gemma long enough to give her a bath!

Kirsty - I'm sorry that you had that feeling of missing out on what you really wanted for your baby's birth. It sounds though like the circumstances were really out of your control and your carers made the best choice for you and your baby.

I sometimes feel in the minority for not being so concerned about how my labour pans out. It is hard to express that these days because the prevailing sentiment is against intervention. I intend to have a natural birth but if things don't work out that way, that is fine too. I feel that I have waited so long for this baby that the end result is all that matters so I have to admit that I completely understand when people opt for the caesarean.

Melbo-Its funny because I was induced and was totally fine with what will happen will happen and if I have to have intervention then I'm cool with that(after all I was induced!!hehehe) and yet afterwards I felt so, well useless really! :-k Weird, but I guess lI did feel like I had been ripped off and yet I was so ready for a c/s as I knew Mum and my sister and my aunties had all had to have them!I guess the mind can be a horrible thing! :(

angelfish, sadly that is true. It's hard to trust the stats as to reasonings of the caesar, one case I recently discussed on BB was where one mum was booked in for a caeser due to 'baby too big / pelvis too small' which is grossly overdiagnosed as it is. Anyway, the midwife was a little suss and decided to go through the patients notes, where she found the woman had asked for a caeser as she was over being pregnant. So not attacking the woman, but the stats we are given on why they are needed are not accurate either.

Hey Kelly

Could I ask you question............I've been told that my pelvis is to small to birth a 'normal' sized bub as has my mum and sister.Could this be a misdiagnosis?Its just that next time I REALLY want to try for a natural birth but everyone in my family is now trying to persuade me to just having an elective c/s this time as when I had Gemma I went through 23 hrs of labour only to have an emergency c/s of which the doc when he opened me up said that there was no way I was having Gem naturally.

Also this may sound really dumb but, does your pelvis actually open more when you are in labour and could this be the real reason why I couldn't birth Gem?And could stress during labour slow or inhibit a natural birth?I got to 9cm dilated then couldn't progress past that and am wondering if it was because I was so worked up and exhausted.

Kirsty,

I can't say to you that I don't agree with a medical diagnosis - that would be bad of me to say as I don't know everyones history and I have no medical training etc., but if you have seen specialists about pelvic problems then it's not my job to argue that.

The 'small pelvis / big baby' thing is well known many years ago to have been going on, and when women started being able to birth their babies at home with no problems, this was when women started doubting this. So it has been around a very long time.

Our bodies are designed to birth babies, and from an independant midwife's mouth, really, unless your pelvis has sustained damage from injury or there is some deformity, then there should be very, very few cases of this - why on earth would we be made not able to birth babies? It doesn't make sense!

Your pelvis does open more for labour, the hormone relaxin is present during pregnancy and relaxes the ligaments for the pelvis to open. By squatting during second stage (pushing) you can get around 30% more pelvic space - it's optimal for pushing.

My tips? Read 'New Active Birth', get the 'Pink Kit' and get yourself some professional birth support - if money is an issue students do it for free or low cost. Don't feel bad or embarassed about a stranger being there, you'll be able to meet her before the birth and get to know her, she'll be more familiar to you than the midwives who you don't get to meet prior and the Ob will only be there for the birth if he / she makes it.

All the best!

Thanks Kelly!I had suspected as much that they may have told my sister and I a white lie about pelvis's being to small etc!I really want to give a natural birth a go and feel last time that I was pushed into a c/s because I was stuck at 9cm.

Thank you and you've now inspired me to not go elective c/s and go the natural!!!! ;)

Kirsty, did your mum and your sister also stop at 9cms? What was the circumstances surrounding that?

There is the possibility that it is in fact as you have been told, but also, having stopped at 9cms, the possibility of something else. Perhaps position, perhaps a psychological block - what do I mean by that? Something going on conciously or unconsiously that is stopping things from going any further. Be it the thought in your mind that you wont be able to birth this baby because your mum and sister couldn't, or perhaps you didn't feel safe where you were birthing or perhaps baby was being born into a difficult emotional situation. These sort of blocks often happen where (for example) the couple who conceived the child are having issues - I have heard many times of mums not being able to get past this to push where the pregnancy wasn't planned, the woman thought by having this baby it would bring them closer together then when the crunch came to the birth - she couldn't push - because it was decision time. I am not saying this happened with you, but birth is soooo deep and complex, perhaps there was some sort of block you can think of which didn't allow baby to come without doubt or hesitation.

At the end of the day, giving it a go and giving your baby and yourself a chance to labour is great, unless strictly advised otherwise of course. Perhaps find yourself a second opinon or a doctor / midwife who will help you.

My labour with Marisa stopped at 5cms so I was augmented. But once Elijah's labour got going, it never stopped - I needed no intervention.

Another idea is to see an Osteo - they are brilliant if you can find a good one and they will help you maximise and understand your pelvic capacity for birth. As I have mentioned squatting is the optimal position for birthing as it gives you up to 30% more pelvic space. The Pink Kit also helps with this. So some great options / ideas there for you to try.

I'm not sure how far my mum got but she had a c/s firstly because I went into distress(don't they always say that!)And then when she had my sister she had a pelvic scan at about 36weeks and they said there was no way she was coming out vaginally as my mum has a small pelvis.

My sister got to 9.5cms then they tried to flip the cervix over her bubs head but my sister was screaming and in distress so they went the c/s.

You know what your saying about physcological elements being invovled in so spot on.My sister had a long labour and was totally exhausted and I had a 23 hour labour and was so tired and out of it and I must say my bub was posterior so the pain was unimaginable and I was in so much distress myself that I'm starting to think thats why they went the emergency c/s.When I thought about it later there was many things that they could have done to 'assist' me to deliver naturally but they never even tried, same with my sister.Then we were both told that our pelvises were to 'small" to birth a normal sized bub!I don't buy it though!How could we get that far during our labours then!I just reckon we were to stressed out, being our first bubs and all.

I'm going to make an appointment to see my old ob again I think.I went public when I had Gemma but was seeing a great ob/fertility specialist as I had trouble conceiving and needed a little help.

Thank you so much for all your advice.I'm not really in tune with how all of this works, but had an idea that I probably could have had a natural birth but because I was stressed they went the emergency c/s.Next time I'm going to be so much more prepared!Time to hit the books and do some serious research! ;)

Edited to add:Corey is completely freaked out at the thought of me trying a VBAC!I think seeing me go through labour again has him nervous!I think a booked in c/s is so much more for the men then us!

Good on ya Kirsty, and you know what, there is HEAPS you can do to help with a cervical lip (where there is still a little bit of cervix left) and it doesn't mean stretching it manually. There's also heaps to be done for a posterior bub. Research optimal foetal positioning and also there are postitions in labour you can do to help with that lip or posterior bub!! :) Sometimes is can be so dependant on the knowedge your team have on how well you manage these things most of the time. Lots of Obs and even midwives in hospitals often don't know things you can do, because their training is so medical, but midwives are more likely to be clued in on this, most definitely birth attendants ;)

Read 'New Active Birth' and 'The Thinking Womans Guide to a Better Birth'.

I just googled 'optimum foetal positioning' and I reckon I did 9/10 things to promote a posterior baby!!Arghhhh!WIsh I knew that before!Am NOT going to be like that next time!!

Ooooh, I'm gonna Google that too, cos my first 2 were posterior!!! :shock:



I actually feel so very sorry for the mothers that don't get to birth vaginally for various reasons!!! It is the most satisfying, heart tugging, overwhelming experience you will ever have!! I can't understand why people would opt out of this when they actually CAN do it!!

I understand those that can't and that must be devastating to most, so why leave the option open to the ones that don't need it?! JMO ;)

It is hard to admit, but I do wonder if my caesar came about from own mental issues with the birth. As much as I really wanted a drug free vaginal birth, I found it difficult once I got there. All the labour pain was in my lower back and I did not get an urge to push, only to clench. My mind was not really helping. I kept on thinking, "I can't cope with the pain now, how am I going to cope with the head coming out". I was also thinking "Oh $h!t, what are we doing having a baby?".

I still don't know whether to go for a VBAC or not next time round. I really need to understand a bit more about the first birth first. All I know is next time I am getting my own birth attendant.

Astrid, it's very common to feel that way... and all that tension and clenching results in more pain! Resisting the 'intensities' as they now like to call it, makes it harder for you to let go and surrender to birth.

In the last birth I attended the other day, I was extra mindful of tension considering she's been doing hypnobirthing - it's amazing how often we do tense up and just by touching her sholders and telling her to release the tension, it works wonders. She was doing it on almost every contraction!

It's hard to have confidence in your own body with birth medicalised to what it is today. It's important to remind yourself that birth is a natural event, not a medical event, unless intervention is required, in a low percent of cases. I could go on forever, but all the stats are on the birth support page in my signature link. ;)

If you feel you need some birth debriefing or birth counselling, (it's a great idea for every mother after every birth IMO...) my teacher does a brilliant job at it, her name is Rhea Dempsey and her website is birthingwisdom. She can help you understand the things you carry as a result of the birth. Wonderful, wonderful woman.

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Weird, but I guess lI did feel like I had been ripped off and yet I was so ready for a c/s as I knew Mum and my sister and my aunties had all had to have them!I guess the mind can be a horrible thing!

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Ikwym, Kirsty.
I went into the whole thing determined to just take it as it comes.
I was sooooo afraid of having a still-born baby that I let the doctors intervene more than I should have (there's a 3 generation history of unexplained still-births in my family - including my older brother born at 42 weeks). When induction was suggested, I was all for it because I thought I would meet my baby sooner (yeah right.... 5 days later when I could have gone into labour on my own!). Even when it was announced that I would need a caesar because "something" was compressing on the cord, I was pretty blase'. "Oh well, so long as the baby comes out alive, I really don't care".
Looking back, I really wish I had a little bit more faith in the natural process of labour.
Once my waters were broken and I experienced proper contractions, it was kind of "fun" (for want of a better word) to be doing "it"! I was finally labouring! I am sooooo glad I at least got to experience that at least!

Actually, Kelly.... I have a question for you. The reason for all my intervention was because of high BP. There were no other symptoms of pre-eclampsia and I was still quite comfortable. Do you think that doctors overreact a little when BP readings are a little high? I guess because I was overweight, it sent alarm bells ringing for them (though they never mentioned it). I hope to be a lot lighter for my next child.

oooo I can't really comment on that one Deb ;) It's hard to be an advocate without crossing lines - need more medical know how and background info for that one. Sometimes we just have to let them do their job, but that doesn't mean don't ask questions - always ask more if you're not sure, ask for a second opinion - heard plenty of cases where a registrar in a public hospital wanted to go to caesar, so couple asked to speak to the consultant (you have a right to ask for them) and the consultant said it needn't go to caesar yet.

So you can always ask and not be afraid that they will think you are stupid or annoying. After all, it is your body, your baby and your birth. You have rights.

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After all, it is your body, your baby and your birth. You have rights.

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I will have to keep that sentence in my head for next time. I was so hell bent on not being a "difficult" patient. I just didn't want to be a burden.
God help 'em next time!! LOL ;)

IKWYM Deb.I was exactly the same.But yep next time I'm standing my ground!!