Caesareans up, but not at this hospital

''It was an amazing feeling'': Audrey Tamburini had a natural birth for Juliette after a caesarean for son Jude, 3 years.
''It was an amazing feeling'': Audrey Tamburini had a natural birth for Juliette after a caesarean for son Jude, 3 years. Photo: Jacky Ghossein

Nothing compared to the joy Audrey Tamburini felt when she walked her new baby girl from her labour room. And it wasn't just seeing her daughter Juliette for the first time, but the walk itself.

"It was an amazing feeling, my body was not sore or incapacitated," she said.

Having her first child via caesarean had left Ms Tamburini feeling disempowered, traumatised and incapacitated. It meant she wanted to try a natural delivery for her next birth - called vaginal birth after caesarean (VABC) - but achieving it wasn't easy.

Only about 12 per cent of women are able to give birth naturally after a caesarean in NSW, and Ms Tamburini said she initially felt a lot of pressure to have another. ''In my first visit to the hospital they scared the hell out of me," she said.

She was lucky to be giving birth at the Royal Hospital for Women, in Randwick, which is actively resisting the state-wide increase in caesareans and supported her to have a natural birth.

"I believe the whole experience helped me to heal emotionally from the C-section, and gave me heaps of confidence and empowerment in the first months of Juliette's life," she said.

A hospital against the tide 

Previously unreleased figures from the NSW Ministry of Health show the NSW caesarean rate rose to 31.3 per cent of women in 2011. This came despite a policy of decreasing caesarean use, which has jumped by 63 per cent since the late 1990s.

The medical co-director of maternity services at the Royal Hospital for Women, Andrew Bisits, said co-operation between doctors and midwives was key to containing the rise. They meet daily to discuss cases and debate treatment.

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"I think one key thing is looking day by day at each decision for a caesarean or any other intervention, and just constantly asking 'could we have done something differently?'" he said.

The caesarean rate at the Royal has decreased to 25 per cent in the public wing of the hospital, down 3 per cent in three years. It has the largest group of "midwifery practices" - teams of midwives who share the care of women throughout their pregnancy - in the state.

The midwifery co-director of maternity services, Helen Jarman, said the hospital redesigned some birthing rooms to make them more comfortable and facilitate water births.

"It all comes down to women having a lot of different ways of getting pain relief and being more comfortable," she said.

But both agree they need to do more, particularly for women like Ms Tamburini.

"I think it's quite possible we could get down to a caesarean rate somewhere around 20 per cent, possibly even lower," Associate Professor Bisits said.

Read stories from other women who have had VBACs, and how they prepared for them, in the Essential Baby forum. You can also read stories by VBAC mums AnneAngela and Liz, and also Emma, who had a homebirth VBAC after two caesareans.