The following can be attributed to Dr Lesley Dixon, Midwifery Advisor, NZ College of Midwives:
“There is no doubt that Caesarean section is an important part of maternity and birth planning for women who may require one for medical reasons. C-sections have the potential to save the lives of women and babies when they are medically required.”
What have we seen in recent years in regards to the rate of elective C-sections?
In 2006 the rate of C-sections in NZ was 24% and rose to 25% by 2015 with 10-11% classed as an elective (planned) C-section. The rate varies depending on the hospital and region.
Most countries have been seeing an increase in Caesarean section rates and the reasons are multi–faceted – they may be related to the model of maternity care as well as the women. The midwifery-led continuity of care model we have in New Zealand appears to support a slower rate of increase and therefore better outcomes for women and babies.
As well as for medical reasons, planned Caesarean sections can sometimes be offered when a woman has had a previous Caesarean. There are many women who have a VBAC birth (Vaginal Birth After Caesarean) and we believe more could and should seriously consider this option. Midwives refer to obstetricians when there are concerns about the woman’s pregnancy that may suggest she needs to have a Caesarean section for medical reasons. Referred women who are currently planning a C-section must understand the risks and benefits, and should ask their obstetrician four key questions:
- Do I really need this?
- What are the risks – to my health or my baby’s health?
- Are there safer options?
- What happens if I wait until I am in labour to make the decision?
Benefits of a Vaginal (natural) childbirth
We know that the hormones of labour and birth are important to support the physiology of both the mother and baby – the transition to parenting for the woman and the transition to life for the baby. The woman’s body releases hormones at different stages of labour and these hormones play an important role in the way the body manages, for example, pain. When the stages of labour and birth are interrupted by an induction, for example, the natural progression of labour and birth is affected and can mean additional interventions are required because the hormones needed in the next stage to help with the pain, are not triggered. Often referred to the Cascade of Intervention, research shows that this can affect the wellbeing of mother and baby in the short and long-term.
Specific reaction to the Singapore study findings:
This Planned C-Section and Association with Early Child Overweight research demonstrates that the way a baby is born has an effect on the long-term health of that baby. It provides more evidence that identifies the importance and significant health benefits of experiencing labour and vaginal birth for the mother and the baby.
The research raises a number of questions about what is happening during birth that supports ongoing health, and whether other interventions also have an effect on the physiological responses of the mother and her baby further affecting their health beyond the labour and post-natal period.
Medical reasons for CS are – placenta praevia, fetal distress, abnormal positioning of the baby.
The World Health Organization recommends a Caesarean section rate of between 10-15% as optimal – higher rates are not associate with reductions in maternal and newborn mortality rates
Known risks of C/S:
Blood clots, anaesthetic complications, increased blood loss (haemorrhage), wound infection, increased risk during future pregnancies. For the baby there is a risk of accidental injury during the operation and an increased risk of the baby developing breathing issues.