Women who stop working at least a month before their baby is due are four times less likely to have a caesarean delivery because they are less tired and anxious, research has found.
Australia's caesarean rate has climbed rapidly in the past 10 years from one-in-five births to more than one-in-three. Women who have caesareans require longer stays in hospital, more attention from staff, have an increased risk of complications from surgery and take longer to recover than women who give birth naturally.
Obstetricians have maintained the soaring rate is due to a rise in the number of older mothers, increased obesity rates and a changing ethnic mix rather than poor medical practice, but midwives believe the rate is higher than it should be because labour is treated as a sickness rather than a normal part of life.
In the study, published yesterday in the Women's Health Issues journal, researchers from the University of California surveyed more than 400 women. Only women who gave birth to single babies with no congenital abnormalities were surveyed.
Previous studies have shown that women who get less than six hours' sleep a night are more likely to choose or accept instructions to have a caesarean, while those who experience "occupational strain" report higher levels of swollen hands and legs and pre-eclampsia, which often leads to surgical intervention.
If we reduce the stress for women, we can reduce the caesarean rate.
"If a woman can potentially rest before labour, she'll have lower stress levels and will be better prepared to cope," the secretary of the NSW Midwives Association, Hannah Dahlen, said. "And if she is on paid maternity leave, she'll also have less financial worries which will lower her anxieties."
About two-thirds of women do not have access to paid maternity leave and 25 per cent work up until the week or day their baby is due.
Dr Dahlen said the most common reasons for a caesarean were a failure to progress in labour, foetal distress and being induced - "all associated with increased anxiety and stress". "If we reduce the stress for women, we can reduce the caesarean rate."
A second study, published in this month's Paediatrics journal, found that women who took less than six weeks off work after giving birth were four times more likely to be unsuccessful in establishing a breastfeeding routine, while those who took less than 12 weeks off were twice as likely as other mothers to fail.
About 82 per cent of the 770 women in the study had a breastfeeding routine, but 23 per cent stopped in the month before returning to work, 29 per cent during the first month after returning and another 20 per cent in the second month.
"It stands to reason that if a woman is at work and hasn't got access to her baby, she will feed less and her milk supply will decrease," Dr Dahlen said. "Breastfeeding has major physical benefits for babies, it reduces medical costs, hospital admissions, increases a baby's IQ and resistance to infection. The longer women can stay off work to care for their babies, the better the outcome for society."
Discuss birth and caesarean deliveries in the Essential Baby forum.