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Each year the Australian Institute of Health and Welfare (AIHW) release a report showing the National Core Maternity Indicators, and each year, Australia sees a rise in recorded birth interventions. Intervention procedures can include pain relief, episiotomies, c-sections, instrumental vaginal birth, and inductions.

 

Australia has one of the highest rates of caesareans in the world and the rate is rising. In 2004 25.3% of selected women had a c-section and in 2017 this rose to 29.3%. The data also showed that c-sections were more common for women in private hospitals with 2 in 5 women using this birth method compared to 1 in 4 selected women birthing in public hospitals. These statistics contradict the WHO recommendation of national rates sitting around 10-15% to achieve optimal outcomes for mums and babies. They also suggest that c-sections only be performed if medically necessary - and sometimes they are absolutely necessary! C-sections do save lives and are important for women with complex needs or those requiring emergency medical interventions. However, often this is not why c-sections are performed.

So why are Australian rates so high? Some have attributed the change to the increasing age and weight of first time mothers, which can present more birth risks, however statistically this does not account for the majority of the rise. If we look at countries that have lower c-section rates, midwives are at the centre of care. In Australian private hospitals obstetricians manage care and in a hospital setting - public or private - birthing women are more likely to be faced with hospital policies that ‘put them on the clock’. This means certain interventions will take place if a woman’s birthing processes do not adhere to their timelines. For example, some hospitals may have a policy about being induced after 40 weeks plus or if you have laboured for a certain number of hours without sufficient dilation. This has led to an increase in induction rates also. In 2004 31% of selected women having their first child were induced by artificial membrane rupture or the use of prostaglandins and/or oxytocin. This rose to 43.1% in 2017.

The National Core Maternity Indicators show a similar trend for VBACs and instrumental vaginal birth, with assisted vaginal birth rising from 23% in 2004 to 26.1% in 2017. Vacuum extraction or forceps are used to quicken birth when it is believed the second stage of labour (the pushing stage) is affecting the baby’s heart rate or blood pressure. There are of course things to way up if you agree to vaginal assistance as the use of instruments can lead to tissue damage in the vagina, perineum and anus. When deciding whether to go ahead with this intervention the safety of mother and baby is of course paramount.

In 2007 32,672 (13.1%) women across Australia had a successful VBAC and in 2017 this decreased to 20,126 (12.1%). Statistics show that mothers who have a caesarean for their first child are more likely to use this birth method for their second child - 86% of women in fact. They also tell us more VBACs occur in a public, rather than private hospitals.

In my work I love supporting women who want to achieve a VBAC. Often their passion and determination is very inspiring and they are very keen to learn techniques that will enable them to birth vaginally. They are also often so happy to hear that with the right support and education a successful VBAC is absolutely possible! If you would like to know more about this process and how I help mums achieve this you can check out my 5 tips for a successful VBAC.

I always tell my clients, I actually don't care how or where you give birth as long as you feel safe, supported and listened too. If those things are happening then you have a fantastic chance of walking out of your birth feeling positive and connected to your incredible birthing power.

So what can you do if you and your baby are not in any danger but interventions are being suggested to you by medical staff? The first thing is to ask yourself whether you want to continue naturally? You may have written this scenario down in your birth plan and have some ideas about how you wish to proceed at this stage. Perhaps you want to try walking, squatting and different positions before accepting interventions.Whatever you decide, educating yourself before birth is key. You will learn about all stages of labour, which will help you make informed decisions throughout your birth. It will also empower and prepare you to cope with whatever birth and motherhood throws at you! You may find yourself in a situation where interventions are absolutely necessary - and that is okay. Whatever your birth ends up looking like the most important thing is that you will be able to make choices about your birth from an empowered and knowledgeable space - which is the best outcome for you and your baby.

To learn more about how birth education courses can help you have a wonderful birth check out my website to see the range of programs on offer.

All the statistics I have included in this article have been sourced from the AIHW online report. For more details you can also read the National Core Maternity Indicators Summary Report.

 

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