Two in five babies are born by Caesarean section in the ACT, according to the AIHW. Photo: File.
Last week, I reported on new dedicated obstetric operating theatres opening this month at the Canberra Hospital, conveniently located near the Centenary Women’s and Children’s Hospital.
It was a good news health story, one the ACT Government was keen to tell. At a cost of $5.5 million, the new theatres and recovery area will mean smoother and safer transfers from the birthing suite to theatre when Caesarean sections are needed in emergencies. It also means less disruption for the theatres in the new Critical Services Building.
All good.
But what shocked me when looking at the number of Caesarean births in the ACT was the mind-boggling figure of 42 per cent for all mothers, higher than the 39 per cent national rate, and 38 per cent for first-time mothers, according to the Australian Institute of Health and Welfare (AIHW). That’s two in five births happening on the operating table.
I knew the rate was high and, like other jurisdictions and countries, had been steadily rising for decades, but having not looked at the data for some time, I did not realise it had breached the 40 per cent mark.
At the beginning of the 1970s, the rate in Australia was 6.4 per cent and had risen to 16.4 per cent by the end of that decade, continuing upwards to where it is today.
According to the World Health Organisation, this steady increase in Caesarean section rates has not been associated with significant maternal or perinatal benefits, and rates higher than 10 per cent are not associated with reductions in maternal and newborn mortality rates. But it also says C-sections save lives when required for medically indicated reasons, and cautions against aiming for a particular rate.
So what’s behind the rise? The AIHW says it may be influenced by maternal and clinical factors and medico-legal concerns, but the reasons for the steep rise remain unexplained.
Doctors point to the rising age of first-time mothers and associated levels of fitness and health issues such as obesity, diabetes, lifestyle, high blood pressure and multiple pregnancies due to fertility treatments.
More women are also electing to have Caesareans for medical reasons, fear of vaginal birth and convenience. One of those new theatres will be for planned C-sections, around two to three a day.
The procedure is considered major surgery and comes with risks to mothers such as postoperative infection, haemorrhage and complications during future pregnancies.
Risks to the baby for planned Caesarean section at less than 39 weeks gestation can include increased rates of neonatal respiratory issues, asthma, obesity and developmental issues.
Post-natal recovery can be longer and more difficult with movement impaired, making it harder to breastfeed.
Other factors contributing to increasing rates include increasingly defensive medicine in the face of a more litigious public, and, according to a recent University of Western Sydney study, the greater likelihood of women having Caesareans in private hospitals.
In 2022, a UNSW study found that an unplanned caesarean birth was 4.2 per cent more likely in a private hospital compared with a public hospital. For first-time mums, it was 7.7 per cent more likely.
Many will say So what? As long as we have a healthy baby, we’re happy.
But this does not come without costs – an average of nearly $12,000 in private care and $8000 in the public system. And whether there is private insurance or Medicare coverage, it remains a cost to the health system. That doesn’t take into account extra days in hospitals, longer recovery times and potential complications.
At a time when hospitals everywhere, including Canberra’s, are under immense financial pressure, this is a burden all taxpayers have to share.
In the 1970s and 80s, the medicalisation of birth was an issue for the women’s movement, which lamented the well-documented cascade of interventions leading to mothers being disempowered and delivery taken out of their hands. But it seems that battle has long been abandoned.
Instead, we have a culture of medical dependence, risk aversion and convenience, with ministers and health authorities tiptoeing around the elephant in the room to support women in whatever direction their ‘birth journey’ takes.
Health Minister Rachel Stephen-Smith said boosting midwifery support was known to increase the chances of vaginal birth but the numbers of Caesareans continue to inexorably rise, indicating that more needs to be done to educate women fully about their health in general, deferring childbirth, and pregnancy and birth itself.
This is not an argument for natural birth at all costs; indeed, our third child was born by emergency Caesarean, nor am I telling women what to do with their bodies.
But a 42 per cent Caesarean rate, the medical, economic and legal factors contributing to it and the consequences for women’s and children’s health and the health system should be ringing alarm bells for health professionals, policy makers and women themselves.
How long before vaginal birth is in the minority? That really would be dystopian.
