We need to talk about maternal-assisted caesareans, an experience some mothers crave

Being more actively involved in your child’s birth is empowering, but education and access is limited

If the concept of a maternal-assisted caesarean – when the birthing mother reaches her gloved hands down to lift her baby out of her abdomen and on to her chest – is news to you, and perhaps slightly shocking, it shouldn’t be.

According to the World Health Organization, Australia’s caesarean rate is rising, with a predicted rate of 45% by 2030.

Data from the latest Australian mothers and babies report by the Australian Institute of Health and Welfare shows that births by c-section have increased by 5% in the past decade, up from 32% in 2010 to 37% in 2020.

For all pregnant women, all over Australia, accessible birth education and preparation is paramount to positive maternal outcomes. Informed choice and women-centred care are two key WHO recommendations for addressing maternal and child health.

But for those planning a caesarean, birth education is limited. If caesarean birth can be more empowering for the mother, we should be giving her the opportunity to learn about it because we know informed birth choices pave the way for positive maternal outcomes.

Maternal-assisted caesareans are a new and relatively rare addition to the Australian maternity system and there aren’t a lot of public conversations about them. But there needs to be, because in the sterile environment of the operating theatre, a maternal-assisted caesarean is a safe way to shift the focus from passive surgery to active birth.

After interviewing more 300 Australian women about their birth experiences, I believe there’s a strong connection between informed choice and a positive birth experience. We can’t deny the truth that exists for many women; that pull-your-baby-on-to-your-chest experience is an opportunity that some mothers deeply and intuitively crave. For some, it’s a precious experience worth advocating for.

Maternal-assisted caesareans are a significant step forwards but there needs to be more opportunities for women to access them, both in private and public hospitals.

Unfortunately for Australian women, maternal-assisted caesareans aren’t readily available. Not all obstetricians perform them and not all agree that it’s worth the risk of infection to the mother or baby.

But there are an increasing number of obstetricians willing to write surgical protocols in line with hospital policies and jump the hurdles to get them approved because they see the value in providing women with safe and supported options in the operating theatre. They understand and respect the importance of shifting the emphasis from surgery and towards a mother-centred experience, even when she is scrubbed in, gloved up and numb from the belly down.

Dr Natalie Elphinstone is one of them. She understands and regularly observes the psychological benefit of maternal-assisted caesareans and is a strong advocate for them.

“For many years we’ve practised caesareans in the operating theatre and it’s just surgery. I wanted to go as far away from that as possible because it’s the birth of your baby,” she says. “Let’s make it the best and most empowering experience that you can have.”

There are potential health benefits too: delayed cord clamping, exposing the baby to the microbiome of the mother’s skin directly after birth, and the increased rates of breastfeeding because of this.

Considering up to one in every three birthing women in Australia will have a caesarean, I believe maternal-assisted caesareans provide women with options. Ultimately, this is what we all want and deserve when we prepare to birth our babies.

They’re not the appropriate choice for all planned caesareans and should only be done when safe to do so, but maternal-assisted caesareans create the opportunity for women to actively participate in bringing their baby from the womb into the world. When we give women birthing options and when we support their informed decisions, we see new mothers entering the postpartum period with a sense of pride and contentment and that paves the way for positive mental health in motherhood.

In a country where one in three women describe their birth experience as traumatic, we should be supporting all women to make informed birth choices – regardless of where they’re birthing, how they’re birthing and who is caring for them along the way. But our choices are only limited by our options, and right now maternal-assisted caesareans are generally only available to those with the financial privilege of private obstetric care.

From a medical perspective we need more obstetricians willing to discuss the psychological benefits of maternally assisted caesareans. We also need more hospitals willing to consider new surgical protocols.

I know from experience that the groundwork starts with birth education. When pregnant women are encouraged and empowered to ask questions, create birth plans and make informed choices, they’ll go to great lengths to seek the birth experience they crave. All women want positive maternal outcomes and for those planning a caesarean, a maternal-assisted caesarean is a big step towards achieving that.

• Sophie Walker is public health expert and is the founder and host of the Australian Birth Stories podcast

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