NSW's runaway caesarean birth rate is set to be reined in by one-third under an ambitious five-year plan to normalise the process of giving birth and reduce unnecessary intervention in public hospitals.
The proportion of surgical births should be reduced to 20 per cent by 2015, from 30 per cent now, and first-time mothers would be attended by the same midwife throughout labour.
The option of labouring in water, although not necessarily water birth, would be offered universally under the mandatory policy.
It's a wonderful idea to introduce policies around use of water in labour, but not necessarily waterbirth. Most units don't permit labouring in water, either due to lack of baths / pools or because the policies do not support it. Waterbirth challenges some doctors and even some midwives; promoting the use of water in labour is a fantastic starting point and from that, let's hope waterbirth becomes more of a standard option in delivery suites. This move also complements the re-intruduction of private midwives back into hospital delivery suites with visiting rights.
The policy, the first of its type in Australia, is modelled on a 2005 British one credited with starting to reverse that country's escalating caesarean rate.
The Minister for Health, Carmel Tebbutt, said the directive was ''designed to support women to have a birth that is as free as possible from invasive medical intervention, while also recognising that labour occurs across a wide spectrum … The safety of mother and child are, of course, paramount.''
The president of the Australian College of Midwives, Hannah Dahlen, said: ''For the last 15 to 20 years [birth interventions] have just gone up and up and up. At some point we have to start coming down again. The policy says, 'Let's stop, let's regroup and try to get a balance.' ''
She emphasised it would remain ''the safest option for some women to have a caesarean section, and women should not feel lesser because they had to have an intervention''.
Only about 13 per cent of women now achieved a vaginal birth after a caesarean, while up to 80 per cent could do so if properly supported. The NSW targets specify a 30 per cent rate by 2012 and 50 per cent by 2015.
''It all depends on how women are supported and how the facility as a whole supports it,'' said Associate Professor Dahlen, a member of the committee that drew up the plan.
It always interests mt that VBAC rates vary so much. 80-90% with private midwives and as low as 1% with private obstetricians. Yes, it's defintely about the level of support that a woman receives.
Ted Weaver, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, applauded the NSW policy to have a single midwife attend first-time mothers, but said this would require a shake-up of workplace rules.
Dr Weaver said the appropriate caesarean rate was about 25 per cent of all births, because the current generation of women represented ''an older population, a fatter population, and a lot of first-time mothers'', Factors which raised their risk.
Michael Chapman, professor of obstetrics and gynaecology at St George Hospital, said the policy would require more senior doctors, who had the expertise to continue with a vaginal birth when manageable complications arose …