A Wollongong midwife has raised concerns about new data that shows the "vast majority" of women who give birth in hospitals now end up with some type of intervention during their labour or birth.
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Statistics from NSW Health's Mother and Babies report for 2021, released last month, shows rising elective and emergency caesarean rates in both public and private hospitals, a reduction in vaginal births, more serious tearing injuries and higher rates of epidurals and inductions than in the past.
The increasing rates of medical interventions are seen across the state, and are also reflected in the statistics for Wollongong's public and private hospitals.
Additionally, while private hospital labour and birth trends have traditionally tended to be more medical, with more inductions, caesareans and interventions like episiotomies, the gap between these procedures in public and private maternity care has narrowed over the past decade.
Midwife and the Vice-President of Wollongong Hospital's NSW Nurses and Midwives Association branch Emma Gedge said the latest yearly statistics showed the rise of medical intervention in birth, which she believes is linked to an increase in birth trauma.
Women across NSW are currently being invited to come forward with their stories of birth trauma as part of a NSW parliamentary inquiry.
"For me the trends we see in the Mother and Babies report are a concern because it seems like we're on this ride into an obstetrically-led model of care rather than a midwifery led model of care, which we know the vast majority of women actually do better in a midwifery led model of care," the union delegate said.
"We're seeing that the vast majority of women who birth through our hospital system end up with some kind of intervention.
"Some of these may be justified, but overall I think we're becoming desensitised to the fact that that women will require some kind of medical intervention to have a baby - and no wonder women are scared of having a baby when they see that.
"I also think the rise of birth trauma and these statistics are linked - for example, when you have such a huge episiotomy rate, of course there is going to be trauma."
In Wollongong Hospital, the percentage of women given an episiotomy - a surgical cut to the area between the anus and vaginal to allow more space for a baby to be born - has gone from 7.6 per cent a decade ago, to just under one in five in the latest year.
The 2021 rate is similar to the episiotomy rate statewide and on par with the rate in the local private hospital, which has traditionally been much higher.
Ms Gedge said episiotomies were commonplace in the 70s and 80s, as it was believed cutting women's vaginal opening would decrease the risk of tearing. However, when research showed this was not the case the procedure became rarer, especially under midwife care in public hospitals.
"It's absolutely insane that we have gone back again to doing episiotomies," Ms Gedge said.
"Now there is a huge amount of women - especially first time mums - who are being cut and that really worries me, because is hasn't improved any other outcomes."
Second degree tearing - where women have tearing which involves the pelvic floor, perineal or vaginal muscles - also increased over the past decade, according to the data.
In 2012, 22.2 per cent of births at Wollongong hospital involved second degree tears, while in the past five years this has increased to affect around 30 per cent of women. This rate is on par with the statewide rate of second degree tearing.
These tears are more common in the private hospital; a decade ago about 30 per cent of women at Figtree Private Hospital had second degree tears, while over the past three years the rate has sat between 37.5 and 40.5 per cent at Wollongong Private Hospital.
Ms Gedge said other statistics in the Mother and Babies report showed a statewide increase in the rate of inductions and the rate of caesareans, especially for first-time mothers.
In Wollongong Hospital, the induction rate has gone from 30.4 per cent in 2012 to 38.8 per cent in 2021, while in Wollongong's private hospitals the rate changed from 37.1 per cent to 40.6 per cent in those ten years.
These are both slightly higher than the NSW rate (35.5 per cent), which also increased in the decade.
Ms Gedge said it was important to note interventions were sometimes necessary, but said current rates indicated unnecessary ones may be being used.
"Inductions are an intervention, which means you have a higher risk of needing pharmacological pain relief or other interventions, because if your body is not ready to go into labour, there can be problems," she said.
"And in caesarean birth, there's a higher risk of complications, so a risk of blood loss or infection for instance, and a higher risk of the baby requiring some type of support after birth.
"It also means you are in pain and unable to be as mobile after birth, and there are often issues about being separated from your baby, and really struggling in those first few weeks of being a new mum."
She said the link to birth trauma came about because of the increasing uncertainty that came with each decision, and the fact that one intervention can lead to others.
"When you have model that is so interventionist, there's more times when a woman is faced with choices of difficult decisions she had to make - at a very stressful time - and this means she may not feel she is able to make an informed choice," Ms Gedge said.
"If you have a higher vacuum, forceps or episiotomy rate, those are things that are happening in the spur of the moment. They are not something that is planned, and so of course that's going to be a traumatic event for a woman."
The nurses union has been campaigning over several years for higher staffing ratios in maternity wards and antenatal clinics, which Ms Gedge said would help to reduce unnecessary and unplanned interventions.
"We need more more midwives, a higher emphasis on continuing of care, and we need women to feel confident about their body's ability to give birth, and we need timely and sensible obstetric intervention, only when it is required," she said.
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Kate McIlwain
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
