We can all agree that non-emergency caesarean sections can increase the risk of harm to mother and baby. But as Adj Prof Tanya Farrell asks, how can we ensure women still have a choice about the type of birth? 

In the face of an upward trend in caesarean births, developed countries around the world are struggling to balance patient safety with the woman’s right to choose.

In the United Kingdom, the Chief Midwife recently came out against ‘normal birth’ targets and measures that have been in place for several years in a bid to reduce the number of caesarean sections carried out. She claimed the directive was potentially unsafe and clinically inappropriate.

I agree. Such a blanket target could devalue the important balance between clinical advice and birth choice by women.

But I also agree that we can do more to reduce caesareans without clear medical indications by ensuring woman are fully informed of the risks and benefits.

Here in Victoria, caesarean rates continue to rise, year on year. In 2020, 38.4 per cent of all births were caesarean sections (29,171 Victorian women). That’s up from 32 per cent just nine years prior.

The rise – and the corresponding fall in unassisted vaginal births – is concerning but needs further investigation. We need to understand what is driving the shift in these numbers and what the consequences have been, both in clinical outcomes but also for the experience of birth for women.

Caesarean sections are absolutely the right course in emergency or complex situations to protect the safety of mothers and babies.

But if there is no medical indications, they come with a higher risk of harm. There’s the potential for heavy bleeding or infection, slower recovery times after childbirth, delays in establishing breastfeeding and skin-to-skin contact, and increased likelihood of complications in future pregnancies.

What we must do is ensure woman and their families are informed of the risks, the effect on experiences, the complications.

And that’s what the 100,000 Lives initiative is seeking to do. It’s not a ‘normal birth’ target. It’s not a performance measure. It’s providing clinicians with best practice guidance, and equipping women and families with the information they need to make decisions.

Together we can help improve care, experiences and outcomes for Victorian families.

Adj Prof Tanya Farrell is Safer Care Victoria’s Senior Maternity Adviser.