Everyone's got an opinion about birth,
they're like arseholes.
But we don't necessarily want to look at everyone's opinion.
I wasn't some girl in the desert
with some witch doctor trying to cut out my clitoris.
I was in a first-world country,
in a top-grade hospital, having a baby.
I was thinking "Is this what death feels like?"
I felt lied to, I felt manipulated and I felt betrayed.
It's like nobody ever has a good experience ever, apparently.
The mummy wars are this factioning between natural birthers
and the caesarean birthers.
This whole story can be seen
as the latest chapter in a 400-year turf battle
between midwives and doctors.
These very different paradigms are actually at the heart
of what is going wrong in maternity care in Australia.
We are 39 weeks tomorrow.
Getting a little bit nervous now, I suppose.
27-year-old Kayla is due to give birth any day now.
When I found out that I was pregnant I was like
"I'm going to book in a caesarean, I want to be completely knocked out,
"I don't want to feel a thing."
But after attending a birth education course called She Births
Kayla and husband Richard had a change of heart about caesareans.
It's the last option now, instead of the first option.
Even the way we feel about medical intervention now,
even the gas, we're basically against all of that now.
- Not against it. - Not all of it.
But we feel that you can handle it now.
Yeah.
These are the things that women have been using
since the beginning of time.
These natural, innate tendencies we have to manage birth.
Nadine Richardson is the founder of She Births.
She's at the forefront of a movement
to change the way we think about birth.
Most of us have got to our 30s or 40s and we're having our babies
and we've not heard anything positive.
It's the wave of doubt, where you start to wonder if you can do it.
And that's really normal.
After undertaking the She Births course,
I do have a bit more of an idea of what I want.
I really want a natural birth, it means a lot to me
and if I didn't get it, I think I'd be pretty upset afterwards.
I'm keen to catch the baby.
- Catch it? - If that's what it's called.
Friends of ours the other day actually had a nine-hour labour
and then an emergency C-section, just on Wednesday this week.
It gives me that doubt.
You have that little bit of doubt, maybe I can't do it...
But at least she had a good crack at it for 19 hours.
I want to be fully aware and fully present
and love that moment.
Aoife is 35 and expecting her first baby sometime in the next week.
Tom, I know he's trying to be supportive,
but if a man is going "You'll be grand, your body's made for it,
"millions of women have done it,"
I just want to punch you sometimes.
If a woman said it then everything's okay.
It's really critical that we prepare for all birth scenarios.
If it's a big baby and it tears, then...
It's a small price to pay for what you really want.
And what would be good for that baby for their whole life.
The debate over the best way to give birth has never been more polarised.
On one side of the divide are those promoting the virtues
of so-called natural or normal birth.
If you can have a good vaginal birth it's going to be so much better
than the caesarean section.
At the other end are those who warn that vaginal birth carries risks,
especially as women are increasingly becoming mothers later in life.
The natural way to do things is for women to fall pregnant
by the age of 19 or 20 and have their first baby shortly thereafter.
That is no longer the case in our world.
These are the birth wars.
A scientific study of Nadine's She Births course
found that participants have
significantly lower rates of medical intervention.
But for the majority of women giving birth in Australia today,
medical intervention is the norm.
That might mean using drugs to induce or speed up labour,
or epidurals to block the pain
an option that more than half of women go for.
For some, the prevalence of these interventions
is a major cause for concern.
One of the problems with intervention
is what we call a cascade of intervention.
So, for example, you might induce a woman
and that may lead to more painful contractions so she has an epidural.
Now it's hard for her to push,
now she ends up with a forceps or a vacuum
or perhaps a caesarean section.
In 2010, the New South Wales government
put itself at the centre of the birth wars
when it introduced Towards Normal Birth
a policy that Professor Hannah Dahlen helped develop.
The caesarean section rate had reached about 28%
and we were all really horrified,
where were we going and where would it stop?
The NSW Health policy
aimed to reduce the caesarean section rate to 20% by 2015.
While the targets haven't been met, the policy remains in effect.
The World Health Organisation has said
around 10-15% caesarean section rate is the ideal level,
beyond that we see no advantage
and we start to see harm to mothers and babies.
In came the doctor,
had a quick scan of my belly and goes
"So, we'll go to surgery this afternoon or in the morning"
and I just balled.
Kate is a mum of three.
After her first baby was delivered by caesarean,
she wanted to avoid medical intervention next time around.
I felt like I'd really missed out on something.
That feeling and that sense of accomplishment.
But when Kate went into labour with her second baby,
things didn't go to plan.
She was given drugs to speed up contractions and then an epidural.
Nothing is presented to you in a way where you have a choice.
Her heart-rate was dropping and so I consented to a C-section.
There was no emergency.
The doctors have a god complex
and they just want to be the puppeteer.
In her third pregnancy,
Kate was determined to have a vaginal delivery.
But with scarring from two previous caesareans,
her uterus ruptured during labour
and she was rushed in for an emergency C-section.
C-sections can be life-saving, I've had one that was life-saving.
But I feel we should be saving those places
for the ones that are needed
and the ones that are going to save lives.
But not everyone agrees we should be trying to reduce caesareans.
That policy, Towards Normal Birth, needs revision,
and quite urgently.
Professor Peter Dietz is a urogynaecologist
specialising in pelvic floor damage.
Attempts at avoiding caesarean sections
will inevitably increase the likelihood
of major trauma to women in childbirth.
Dietz believes that institutional pressure to avoid caesareans
has meant more babies are delivered with forceps.
They're like a hospital version of barbeque tongs
used to pull out babies.
Forceps rates have risen very substantially
and in a historically unprecedented way.
And of course it has been accelerated and supported
by Towards Normal Birth.
Across NSW, the use of forceps increased from 3.1 to 4.7%
between 2005 and 2016.
But at some major hospitals it's gone even higher,
quadrupling to over 10%.
That comes at a cost.
If somebody has her baby with a normal delivery,
the likelihood of a major pelvic floor muscle tear is about 10%.
If she has that baby by forceps, it's over 40%.
Major irreversible damage that nobody at this point in time can fix.
We're painted this picture that if we do all the right things,
we can have a natural birth
and that is your rite of passage as a woman.
Amy Dawes was 33
when she had her first baby at a public hospital in Sydney.
I pushed and she wasn't coming into the world,
and we were told that she would probably come
via caesarean or high forceps.
I knew all the risks involved with a caesarean section,
but I knew nothing about
what could happen to my body with forceps.
But forceps were just what the doctors recommended...
and while her daughter was born happy and healthy,
the birth took its toll on Amy.
I was told at the time that I'd sustained a third-degree tear
but they were also having trouble stemming the bleeding.
I was thinking "Is this what death feels like?"
It wasn't until months later
that Amy learned just how damaged her body really was.
I started seeing a pelvic health physiotherapist,
she likened my injuries to that of being in a car crash.
I'm now 37, I feel in some ways like I'm 80
because I was suffering from faecal incontinence.
I need to carry wet wipes, not just for my baby.
While recovering from her injuries,
Amy co-founded the Australasian Birth Trauma Association,
along with Professor Dietz.
I would strongly advise my colleagues to cease doing forceps
in first-time mums that are over the age of 30.
It's a seriously bad idea.
I am in total agreement,
forceps, I think, should be faded out.
But the answer isn't to increase caesarean section.
The answer is to expand continuity of midwifery care.
The Towards Normal Birth policy set a target for 35% of women in NSW
to give birth in midwife-led services.
Midwifery care leads to less intervention, fewer forceps,
fewer vacuums, less pain relief needed, and lower cost.
So what is so difficult to get about this?
A major review of global research
found that women who have babies through midwife-led services
are more likely to give birth without medical intervention.
They're also more likely to be satisfied with their care.
But the review also found that midwife-led care
does not lower your chances of needing a caesarean...
or of tearing during labour.
The midwives talked about it as being such a wonderful, serene
joyful experience, I just thought that's what I'd have.
I wasn't educated on what could go wrong.
Danielle is one of the 8% of women in New South Wales
to have a midwife-led birth.
Danielle gave birth in a pool, without medical intervention,
through a stand-alone midwifery service in Sydney.
I gave birth to my daughter and they put her up on my chest
which still is the best moment of that whole experience.
What I didn't know at the time was I'd had quite a lot of blood loss.
After two hours, Danielle was transferred to the nearest hospital,
about 15 kilometres away,
where she was treated for external and internal tearing.
I feel like they, the midwives, waited too long to transfer me,
I think they should have realised sooner
that it was above their capability.
Doctors have since told Danielle that quicker treatment
may have improved her outcome.
A year later she's still having symptoms from the tearing.
It's still painful to do yoga,
painful if I stand up for too long, like a throbbing, or when I walk
and obviously intercourse is painful.
I'd spoken to my midwife three months afterwards
when I was having the issues and she said something along the lines of
"Oh, that's just the damage that comes with pregnancy."
It shouldn't be normal and it shouldn't be downplayed.
For a whole number of complications of pregnancy
and potential interventions,
informed consent can only be obtained by doctors.
Which means that the midwifery-only clinic is from my point of view,
a legal impossibility.
Obstetricians see more midwifery care
as a threat to their own incomes and their own practice.
27-year-old Kayla has just gone into labour.
The pain is not favourable,
but manageable.
At the moment.
As Richard has been referencing from a book,
as long as I feel comfortable and safe then I'm staying here.
There's this pressure down there.
Okay? Could I get started?
(AC/DC PLAYS)
Richard proposed to me at AC/DC
in the Mosh Pit
during "You Shook Me All Night Long".
Ow! Ow...
Meanwhile, at a hospital on the other side of Sydney,
fellow She Births graduate Aoife has just given birth to her son.
It's wonderful. I love him so much.
You just can't imagine
how much you're going to love something like this.
His heart started decelerating quite a bit
so the obstetricians said we can get him out with forceps.
I was like "Would a caesarean be safer?"
and she said "No, we can do it with forceps, it'll be fine."
I did tear,
but I knew that that was the right path to take.
I'm so glad that I had done the She Births.
There is no trophy that you get with a natural birth.
Like, the trophy is the baby from any birth.
But you can make every birth beautiful.
It was honestly fucked up.
There is no chance in hell
that I would ever go through this experience again
without any kind of pain relief.
Some women can do it - hats off to them.
Just pushed a little too much and teared.
Second-degree tearing.
But I don't think I could do a caesarean,
I suppose it just would just depend.
But he was worth it.
In a statement to The Feed,
a spokesperson for NSW Health said...
The reality is the caesarean section rate has not reduced.
The caesarean section rate now is higher than ever.
Towards Normal Birth has comprehensively failed.
There were some fairly vocal, may I say, obstetricians
who were very determined for it not to succeed
We're seeing these two camps really not working together.
Towards Normal Birth is now under review.
The Feed invited NSW Health to respond to claims
that the policy has increased the use of forceps,
leading to more birth trauma.
We didn't receive a response.
We're very frightened increasingly of birth
and we're passing that fear on to women.
I don't think women need to be given all the risks and complications.
We empower women with knowledge.
How can you make a decision
without knowing the full risks of both modes of delivery?
That looks pretty bad...
We need to talk to people
about the complications that they may be facing.
If you want to put it like that, we have to frighten people.
Information must be based on the highest level evidence,
not the bits you hand-picked because it suited your agenda.
I'd love to see an unbiased approach to childbirth,
to treat each woman as an individual, not one-size-fits-all.
Captions (c) SBS Australia 2018