What do we understand are the drivers for rising caesarean section - Debunking myths

Birth interventions continue to increase in Australia with many attributed to demographic or medical factors. While timely maternity interventions can be lifesaving for a proportion of women and babies, many occur without good evidence. A Queensland Health Normal Birth Guideline was published in 2012 to support physiological birth and promote healthy birth outcomes for women and their babies. In 2019 normal birth rates were observed to have progressively declined. An understanding of factors contributing to lower normal birth rates and increasing caesarean sections was required. To identify drivers for rising caesarean section rates in Queensland post introduction of a Normal Birth Guideline. Women’s perinatal data for five years prior and five years post the introduction of a Normal Birth Guideline were sourced from the Queensland Health statistical services branch. Women with no medical conditions, low risk pregnancy, gestations between 37 weeks to 41 weeks and 6 days, single fetus, cephalic presentation, live born, and receiving public care were analysed by spontaneous or induced labour, mode of pain relief, and mode of birth. More than 500,000 women’s data were included. Preliminary data indicate women who spontaneously laboured were half as likely to require epidural for pain relief during labour. While caesarean section rose in women who had an induction compared to those without, the incidence of caesarean section tripled for women who were induced and also had an epidural compared to women who laboured spontaneously without epidural. Age, BMI, Aboriginality, diabetes or hypertension were amongst variables not found to be major contributors to caesarean section in this cohort. Using a similar approach to analysing women’s births to that of Eugene Declercq in the United States, indicates women’s demographic features are an unlikely independent major contributor to declining normal birth rates. Effective education for normal birth and of intrapartum epidural pain relief for informed decision making prior to and during labour is required.