Do women choose or consent to caesarean delivery?

In her recent UTSpeaks public lecture To Push or Pull?, Professor Fenwick discussed the findings of interviews with 210 women in Queensland and Western Australia that revealed fear as the strongest motive for women to undergo caesarean section where there was no clear-cut medical reason for it.

Professor Fenwick said that while the media liked to propose vanity or convenience as reasons for the deliberate choice of caesarean section, the research findings supported the notion that most women were in favour of natural birth until convinced otherwise.

She said some women having their first baby were particularly fearful of the unknown and were influenced by medical and family advice that featured horror stories and assertions that surgical delivery was safer for both mother and baby.

"This is despite clear evidence that women who undergo caesarean sections are at increased risk of surgical complications and emotional distress and can suffer difficulties with bonding and breastfeeding," Professor Fenwick said. Evidence also pointed to a greater risk of asthma and diabetes among caesarean-born children.

"However, the growing voice of concern about unnecessary caesarean delivery has been countered by an increasing medical discourse that dismisses such concerns as illogical and ill-founded.

"This, of course, is based on a cultural worldview that reinforces that the health of the baby is paramount and that the process of birth itself is of little or no consequence, or indeed is 'dangerous'.

"Under these circumstances caesarean birth becomes embraced as a safe and ordered alternative to vaginal birth and some discomfort to the woman is seen as a reasonable price to pay to 'ensure' the process of childbirth results in a healthy baby.

"Simultaneously we start to see an unfounded argument in the literature suggesting that women themselves are to blame for the rise because they are 'choosing' caesarean section.

"Such medical management decreases women's control of birthing, creates a power imbalance in favour of intervention and alienates women from a potentially empowering experience – a normal but significant life event that is extremely important to women, families, communities and society as a whole."

Professor Fenwick said that in a system where midwives also operated in a culture of fear, the challenge was to promote childbirth as normal and safe, to increase cultural knowledge around birth and continue advocacy for social models of maternity care that that put the woman and her family at the centre within a collaborative system.


Editor's Note: For more information, contact Terry Clinton (ph. +61 2 9514 1623).