Caesareans hit record levels as mums get older

Michelle Baguley and her 6 week old baby Neve. Photo / Jason Dorday

A quarter of all New Zealand babies are born by caesarean section and one in 10 mothers books the operation in advance.

But experts say the rise is driven by changes in medicine and greater numbers of older mothers, rather than women being too posh to push.

The number of elective caesareans in New Zealand has risen from 7 per cent of total births a decade ago to more than 10 per cent in 2006, the latest Ministry of Health figures reveal.

Of the 14,362 caesareans performed that year, 60 per cent were urgent procedures, where the decision to operate was made during labour. The rest were elective, where the mother made the decision during pregnancy.

But that choice was still likely to be based on clinical reasons, said AUT University's head of midwifery Jackie Gunn. She said medical advances meant more women with conditions that carried a greater risk of complications were able to give birth.

"There are women who have illnesses who would not have had children 10 years ago," she said.

And a policy shift which followed research showing caesareans were safer for breech babies - those born feet or buttocks first - also accounts for some of the increase.

"If women were making a lifestyle choice I think the figures would be much higher," she said.

But Gunn agreed there may be "some societal issues" and said opting for surgery was more acceptable than it was 10 years ago.

Caesareans account for 26 per cent of births in the Auckland and Waitemata district health board areas, and about two-fifths of them are elective caesareans.

The rates are much lower in Counties Manukau, which has a high proportion of Maori and Pacific women, who are less likely to opt for surgery or need an urgent procedure.

Waitemata clinical director of obstetrics Sue Belgrave said increasing numbers of older mothers were a factor. Health ministry figures show mothers older than 30 now outnumber those aged 29 and under.

Older women face more complications during childbirth and account for a high proportion of all caesareans.

Belgrave said many women who had a caesarean for their first child chose it again for later pregnancies, because of the extra risk and uncertainty they faced.

The operations carried a huge cost for health boards. "It involves a trip to the operating theatre, it involves an anaesthetist, an operating team, and that's expensive."

But she said it was unrealistic for New Zealand hospitals to aim for the World Health Organisation standards of 10 to 15 per cent of births by caesarean, when most developed countries had rates similar to ours.

She believed the choice was not about convenience for most women and Waitemata mothers could not choose the day they gave birth.

"I think women don't like the uncertainty of outcome with labour, I think that's more of an issue than just convenience."

Health ministry chief child and youth health adviser Pat Tuohy said a key reason for the increase was complications relating to older mothers.

Others were women who needed a caesarean opting for it with subsequent births, and complications resulting from deliveries being induced.

What comes naturally

Giving birth naturally was "fantastic", says Kaz Orr.

"I had an amazing midwife, my husband was there, and it was an amazing and overwhelming experience."

The Auckland mother-of-two said giving birth made her feel proud of her body.

"It's only really during pregnancy, childbirth and breastfeeding that you realise - that's pretty clever stuff, what the female body can do," she said.

"I did have epidurals, and they were fantastic, but even with pain relief you have a very positive, overwhelmingly cool experience."

The 34-year-old said opting for caesarean never occurred to her while she was pregnant with Mia, 3, and Zoe, 5 months.

"But if you have a medical reason - absolutely.

"I was healthy and the babies were healthy, but if at any point the midwife had said the babies were in danger, I would have said, 'Do what you've got to do'."

Right choice for nervous mum

Michelle Baguley says she knew a caesarean was right for her - but faced a lot of pressure to change her mind.

"I had people ringing me the night before the c-section, saying 'what are you doing this for?' It's a personal decision... and I wanted people to respect that."

Baguley says both her children were born by caesarean because of her fear of childbirth and a family history that suggested she was likely to have a large baby.

"Even my husband started off saying 'millions of women have done it before'.

"He gradually came around and now he thinks it was the best idea I've ever had."

The Auckland mother says she had a "miracle recovery" after the birth of her first child, Mia, 18 months ago.

Bouncing back from the birth of Neve six months ago hasn't been so easy, but Baguley says she would make the same choice again. "It was the right thing for me, I firmly believe it."