C-Sections Versus Natural Births: Experts Have Their Say

'Can't we just start providing women with what they need?'

30/08/2016 10:06 AM AEST | Updated 30/08/2016 10:07 AM AEST
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C-sections are on the rise in Australia... but is this really a cause for concern?

The average birth weight for a baby in Australia is just shy of three and a half kilos, which, according to Sprout pregnancy, roughly equates to the size of a pumpkin.

So let's be real. Before we delve into the nitty gritty of delivery options, it's probably helpful to acknowledge there is no 'ideal' way of getting something that size and weight out of your body. Whether a woman decides to pursue a natural delivery or a caesarean section is a) highly personal and b) not going to be easy on her physically, regardless of the absence or presence of drugs, surgery or all the Lamaze techniques in the world.

That said, there is still a lot of debate surrounding the 'best' option when it comes to delivering a baby. So what's the deal? Is one method really preferable to the other? Or is the whole discussion something that's been over-hyped, over-analysed and, as a result, overwrought?


"This notion of weighing up vaginal birth versus a C-section as a big debate, and considering the pros and cons as if you are trying to choose between two cars... even the way we keep making it a debate and then we make it this versus that... it's just a little bit weird," Professor Jenny Gamble, head of midwifery at Griffith University told The Huffington Post Australia.

"There's this distortion around child birth and women's expectations. They are approaching the situation asking, 'How do I best manage this? How do I keep even-keeled? How do I step over this like it's a small grate in the road rather than an existential life experience?'

"It's like the other view has been lost to many women. The other view being -- and I say this to people all the time -- can't we just start providing women with what they need?"

According to Gamble, what women need during childbirth is security as well as access to different options, and the ability to make up their own minds where possible.

"They want to feel safe and be safe. They want to trust their care providers. They want to feel like they have a high degree of choice and control," Gamble said. "If we just started talking to women about what they need instead of asking 'do you want a caesarean or vaginal birth?' then this big debate and all the other stuff that goes with it would start disappearing into the background."

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There is no 'right' or 'wrong' way to bring a baby into this world, as long as both mum and bub are safe during the process.

All that being said, the C-section versus vaginal birth debate is one that's still very much alive and kicking in Australia, especially given the fact C-sections are on the rise.

"There is a trend of an increased number of C-sections performed for medical reasons in Australia," Professor Caroline de Costa, professor of obstetrics and gynaecology of the College of Medicine at James Cook University told The Huffington Post Australia. "And there are some very definite reasons for this.

"Firstly, women are generally having babies much later and that's largely a choice thing to do with their lives and careers. I believe the [current] average age for a women having her first child is around 30, whereas it used to be more like 21.

"Also, women are much heavier, with 65 percent of Australian pregnant women being overweight or obese when they commence pregnancy.

"Both these things can lead to predisposed complications in pregnancy, including gestational diabetes. This can quite often lead to a woman having a C-section."

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Welcome to the world, little one.

Some women are also electing to request caesarean sections, regardless of any pre-existing medical conditions.

"I'd say there are about three to four percent of women in Australia who do this," de Costa said. "Usually they are in their late 30s, usually they are private patients. Most of them are planning to have one or two children at the most and they want to be in control and make an informed decision."

But according to the World Health Organisation, the rate of caesarean sections in Australia (28.8 percent in 2010) is already too high, and there should be no reason to see figures above 10 - 15 percent. However, in de Costa's view, not only is this figure "too low to be realistic" but a ridiculous goal to set in the first place.

"The whole idea of having a figure to reach is not a good way to go about it," de Costa said. "Women are individuals and it's important to work out what's best for each of them.

"You can't compare the population now to the population 20-30 years ago, and you can't compare Australia to a developing country where the resources are different."

According to Professor Gamble, the 'c-section versus natural birth' debate is taking the focus away from what's important, and that is the individual needs of every mother.

In saying this, both de Costa and Gamble agree the perception of the C-section being the 'easy way out' is false (an opinion also held by this woman, whose Facebook post detailing her caesarean experience recently went viral).

"It's a big medical procedure and it has short, medium and long term consequences," Gamble said. "What it should come down to is the balance of risk and benefit, that's the decision for a C-section. But that's not as a preferential alternative to vaginal birth. That is a skewed way of looking at it."

"Undoubtedly there are risks with a C-section. They are small but they are definite," de Costa agreed. "But there are risks to having a baby. There are risks to labour and vaginal birth. With a natural birth, long-term, you may have damage to your pelvic floor or you may require surgery for prolapse and incontinence.

"But looking at C-sections, if you have more than two, there is a greater risk of the placenta causing problems in other pregnancies. There are more risks if you are overweight than if you have a normal BMI... there are a whole lot of arguments for and against.

"Even as a medical person, it's hard to know how much weight to place on them all."

Sally Anscombe

So where does all this leave us?

Essentially, Australia is seeing an increase in C-sections, both elective and medical, and as a result, many health professionals are advocating for a return to vaginal births.

But as for what's right for you and your baby, both Gamble and de Costa say forget about the big debate and forget about trying to navigate labour as a chore rather than what it is: a very, very big physical and emotional deal.

"I just believe in telling women as much as I can," de Costa said. "I do very little obstetrics practice these days but I did it for 40 years, and I have noticed [these days] women do seem to want not only choices, but the 'perfect outcome'. They are much more concerned about this than they were when I started obstetrics 30 or 40 years ago.

"By all means do your research, look at the internet, then talk about what you find with your doctor and midwife and partner and try to work out what you want. But if you make the decision you want to have a vaginal birth, you need to have an open mind because things can change. Quite a number of C-sections are done in labour because there are complications developing, and the baby gets tired or distressed and it becomes necessary.

"It's important to remember it's not your fault if things change. Have a discussion with your midwife or obstetrician afterwards, have them explain why it was necessary [to do what they did].

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When you have this little face to look at, does it really matter how they arrived, as long as it was safely?

"Having a baby is fun, and most babies are healthy and most mothers are healthy," de Costa continued. "But things can go wrong, especially in an older population with a higher incidence of pre-existing medical conditions."

"For me, what I don't like is how we've diluted this experience into a shallow debate like you're buying a new car," Gamble said. "When in fact, being pregnant and labouring and birthing is an existential life experience that has so much potential to be the most enriching thing in the world that you'll ever do.

"Women shouldn't throw that experience away. What they need is options, which, in my opinion, they don't currently have."

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