'C-section or forceps? I would choose the caesarean every time.'

A submission to a UK health review by Hans Peter Dietz, a professor in obstetrics and gynaecology at the University of Sydney, suggests that the push to drive down caesarean rates may be contributing to an increase in injuries to women during forceps assisted deliveries.

As reported by The Motherish, “Professor Dietz’s team showed 81 per cent of women who had a forceps delivery suffered damage. The potential fallout from an attempt to reduce caesarean section rates included increasing rates of maternal pelvic floor tears from forceps deliveries, postpartum haemorrhages as a result of long second stage labours, and uterine ruptures in vaginal births after preview caesarean deliveries.”

This begs the question, what are we doing to women in the race to cut the number of caesareans?

caesarean in progress
“This begs the question, what are we doing to women in the race to cut the number of caesareans?” (image via iStock)

Professor Dietz’s submission said, “The relentless pressure to reduce caesarean section rates has, according to our modelling at my unit at the University of Sydney, resulted in over 100,000 excess case of major maternal trauma to the pelvic floor and anal sphincter in England since 2005 due to the increase in forceps alone.”

The Motherish reported, “Professor Dietz has previously noted that while countries such as Denmark, Sweden and Germany had almost completely abandoned forceps in favour of vacuum extraction, their use was growing in parts of Australia.

“In NSW, forceps-assisted deliveries in public hospitals accounted for 4.3 per cent of births in 2012, up from 3.1 per cent in 2008.”

There are a few reasonably uncontested facts that we should lay on the table here.

First, caesarean rates are on the rise in Australia. They’ve gone from 19 per cent to 32 per cent in the past decade.

Second, where a caesarean is not medically necessary, it’s probably better for a pregnant woman to attempt a natural birth.


Third, while cutting the caesarean rate is generally a good thing, there are risks associated with all delivery methods.

But it’s a real worry if statistics based on the general population have a negative impact on an individual labouring woman. Put another way, if the pressure on medical practitioners from population health advocates is impacting care decisions for individual women, that’s a potential problem.

Are we unnecessarily demonising caesarean delivery and placing women and their babies at unnecessary or greater risk?

I’ve been extraordinarily lucky to have had two very positive but very different birth experiences.

WATCH: The things we were not told about giving birth. Post continues after video…

My first was an elective caesarean for a breech baby. I wasn’t forced to choose to deliver one way or another. My ante-natal care team offered me a natural birth or a caesarean. They talked me through all the benefits and the risks of both options and said it was entirely up to me, one way or another.


My second birth was a natural vaginal birth. It was fairly closely monitored, but again, I benefited from a delivery team who gave me great advice and then gave me the autonomy to make my own decisions about my body.

While I loved every moment of my vaginal birth (apparently I didn’t express love for it at the time, but let’s not get caught up in the details) my caesarean was a joyful, funny, warm experience. My husband and I welcomed our son into the world with delight, surrounded by a supportive and kind medical team (who found my morphine infused broadcasts wildly funny.)

Alys and her daughter Claire, just a few weeks after her birth. image supplied.

If you asked me now to choose between having a natural birth and a caesarean, I would choose the natural birth and that’s despite the fact that I didn’t get an epidural. (It was too late by the time I asked for it – I assure you, I have no pain relief-free labour bragging rights.)

And, if you asked me to choose between having a c-section and having a forceps assisted delivery, I would choose the caesarean.

But the point is, I had a say in what happened to me. I was given choices and those choices were respected.

I have no doubt that for the most part, most women are given choices and their choices are respected. That’s what good doctors, nurses and midwives do.