In recent decades, maternity health policy in Australia has promoted vaginal delivery and prioritised reducing the rates of delivery by caesarean section.
In NSW, the maternity health policy, Towards Normal Birth in NSW was developed in 2010 in response to the Mothers and Babies Report 2006 which revealed that both elective and emergency caesarean section operations in NSW hospitals had increased by about 10%.
And whilst it makes sense to reduce the risks to women posed by having unnecessary caesarean section deliveries, including life-threatening complications such as haemorrhage or pulmonary embolism, there also needs to be a focus on avoiding the life-altering injuries that can be sustained during a traumatic vaginal birth.
With increasing maternal ages and one in five expectant mothers now obese and another quarter overweight, Australia has a large portion of expectant mothers with high risk factors for injury during vaginal birth.
This is because as women age, the muscles and ligaments become less malleable, meaning that it is harder to stretch the birth canal. In addition, older mothers are more likely to deliver their babies later, meaning the babies are larger and harder to deliver. Obesity and lack of general fitness and flexibility also hinders the birthing process.
Forceps delivery, for example, is likely to double the risk of injuries such as urinary and faecal incontinence that can be sustained during a vaginal delivery. This is especially so if an episiotomy is not performed with the forceps delivery. Other complications that can occur during traumatic vaginal deliveries are deep tears to the vaginal wall and the perineum (the area between the anus and the vagina) and damage to ligaments and muscles in the pelvic region that lead to ongoing disability and pain. Unsurprisingly, physical injuries that prevent women engaging in sexual activity contribute to the breakdown of relationships.
If the rate of complaints and negligence cases brought against doctors and hospitals is any indication, it seems that an ever-increasing number of women are no longer willing to accept that the injuries they sustained during a vaginal delivery are a natural and inevitable result of the birthing process.
Right now, only women having caesarean sections need to sign consent forms. However, the question is whether doctors should also have the legal obligation to explain the risks of a vaginal delivery, particularly to those at high risk of injury, and whether women should be given more autonomy in deciding how they will deliver their babies. Really importantly, these discussions should be taking place much earlier and certainly before the situation has become an emergency.
Indeed, amongst the dozen or so maternal birth trauma cases seen by this firm, the lack of information and choice that these women were given during the birthing process was an important issue for all of them.