What to eat when you're pregnant
You've heard the rumours that pregnant women in some countries are chowing down on soft cheese and raw fish? Here's what science has to say about it.
Leanne Larwood was diagnosed in her 20s with a prolapse, which doctors could neither explain nor cure.
"I was told early on that I may have trouble staying pregnant due to this and that if I did I would definitely need a caesarean," she said.
Yet when she became pregnant with her first child, Aiden, Ms Larwood said she was encouraged by doctors, nurses and hospital staff to give birth naturally despite the medical risks.
"I ended up having to call my specialist and getting him to send them a letter saying I was not under any circumstances to have a natural birth," she said, "and that even going into labour could impact on my pelvic floor."
Her experience is an example of what Hans Peter Dietz, a professor in obstetrics and gynaecology at Sydney Medical School Nepean, calls "natural childbirth ideology" or a preference for a vaginal birth without any medical intervention.
Professor Dietz said there is nothing wrong with this principle provided it is safe for mother and child.
"However, this preference often leads to ignoring situations of increased risk, either out of sheer ignorance, a lack of training or because of ideological preferences," he said.
Natural childbirth ideology was promoted by many midwives "not the least because it empowers them", he said. "Increasingly, this has disempowered obstetricians and led to some of us opting in on this ideology in an attempt to reduce friction in the workplace, and to enable careers."
Ms Larwood, from Blacktown, said the attempts to dissuade her from giving birth by caesarean section were "very traumatic".
"I was very frightened because they didn't seem to understand that I was at risk," she said.
Ms Larwood faced similar pressure when pregnant with second child, Amelia, until she said: "I told them to find my old files. It wasn't questioned again."
In Natural childbirth ideology is endangering women and babies, Professor Dietz and co-author Lynda Exton said caesarean rates had risen in Australia because of demographic factors such as obesity, increased age of first delivery, longer gestation and diabetes.
The Towards Normal Birth policy directive aims to increase the vaginal birth rate in NSW and decrease the caesarean rate.
A NSW Health spokeswoman said the policy is in line with international practice and notes that unnecessary interference in the natural process of birth may lead to a "cascade of intervention".
"However, while it promotes normal birth and reduction of technological intervention where possible, the policy acknowledges that some women will have or develop risk factors that may require intervention, including caesarean section," she said.
Dietz and Exton argue that government policies in NSW, England and New Zealand seeking to cut caesarean rates "were largely produced by politicians, administrators and political activists, with sometimes marginal involvement of obstetrician researchers and clinicians".
"There is evidence that lower caesarean section rates are associated with higher mortality, both for women and babies," they write.
The authors also argue in the Australian and New Zealand Journal of Obstetrics and Gynaecology that rates of dangerous and traumatic childbirth are rising, pointing out that forceps deliveries in some Sydney hospitals are more than 10 per cent of all births.
David Ellwood, a professor at Griffith University's School of Medicine, said CS rates should be monitored to ensure they are performed at an optimal rate.
More than 30 per cent of all babies in Australia are born by caesarean section, but Professor Ellwood said in private hospitals the figure was closer to 40 per cent.
"I don't know what the optimal rate for Australia is," he said. "I'm very certain the current rate is too high. And I'm very certain the rate 50 years ago was too low."
In Every caesarean section must count, Professor Ellwood and co-author Jeremy Oats suggest there is a growing body of evidence that continuously increasing the caesarean rate does not lead to improvements in birth outcomes.
Caesareans also have risks, ranging from organ damage and blood loss during the procedure to impacts upon later pregnancies.
Professor Ellwood said natural childbirth should be encouraged if it is safe for the mother and baby, while caesareans should be performed for women when medically required.
He saw no evidence of an ideology favouring natural childbirth that was endangering mothers and babies.
Sally Cusack, the NSW branch president of Maternity Choices Australia, said: "I feel that our best bet for improving birth and minimising trauma (not just to mothers and babies, but to clinicians as well) is to focus on providing continuity of midwifery-led care to most, if not all, Australian women."
She said it was a "national scandal" that health services withheld midwifery-led care when there was evidence to suggest it improved outcomes and lowered costs.
Ms Cusack agreed that information about the risks of any procedure should not be withheld from pregnant women.
Studies have shown that up to 30 per cent of women in Australia used words such as terrifying and petrifying to describe their expectations of birth.
Ms Larwood said there is a stigma attached to having a caesarean even when it is medically required.
"I get looks of sadness that I didn't get the birth experience," she said. "I always get asked why ... No one ever asks someone who had a 'normal' birth why they did it.
"But I don't care. I have two beautiful babies who are healthy and happy and they get to have their Mum in one piece."