From natural birth to caesarean: women must be given unbiased information

Decisions in pregnancy and birth can be fraught with confusion and guilt. Many women wish to increase their knowledge by seeking health information from official sources. It is important that this information is factual and unbiased.

Every pregnant person prepares for their birth experience with a unique set of preferences. Naturally, these factors vary from person to person, and can result in vastly different choices. This can range from natural birth without intervention, to requesting a planned birth via induction of labour or caesarean section.

These choices are equally valid, and can be respected simultaneously by maternity care providers.

What is essential for women to be able to make these choices, however, is clear and unbiased information.

Unfortunately, an official New South Wales information brochure for pregnant women entitled “What you need to know about a caesarean birth” did not meet these standards.

Freely available to download from a major NSW hospital website, the brochure was removed on Saturday after public concern. Western Sydney Local Health District have subsequently apologised and stated that they do not endorse the information in the document: “Western Sydney Local Health District (WSLHD) apologises for any concern or offence caused by the publication of this document. We do not endorse the information expressed in the document and have removed it from the WSLHD website. We are currently in the process of reviewing our website upload protocols and approval processes to ensure we only publish authorised documents.”

Unfortunately, for many women and families, the harm may have already been done.

The pamphlet presented a one-sided take on caesarean birth and largely focused on possible negative outcomes. It incorrectly claimed that caesarean birth “causes a big increase” in a wide range of childhood conditions, from asthma and obesity to a developmental delay. While there is a lot of population level research looking at various associations, there is simply no evidence that caesarean birth causes these outcomes.

The pamphlet stated “the risk of developing urinary incontinence after vaginal birth is like the risk of your child having autism after a caesarean birth”. This false equivalence is problematic for a number of reasons.

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Firstly, improved understanding and acceptance means that neurodiversity is not considered a “risk” by many, but as a difference to be celebrated.

Secondly, autism is a complex condition that may relate to various environmental, intrauterine and genetic factors. While autism may be associated with some of the factors that make caesarean birth more likely, there is simply no evidence that autism is caused by caesarean birth.

Thirdly, the actual risk of urinary incontinence after birth is thought to be at least a third of all women who give birth vaginally. In contrast with autism and caesarean, there is clear cause and effect between increased rates of urinary incontinence and the direct physical impacts of vaginal birth.

In a society where women frequently experience guilt and shame for their birth and parenting circumstances, and with the high prevalence of birth trauma and perinatal mental health conditions, misleading health messaging can be both counterproductive and potentially harmful.

Caesarean birth on maternal request, or where there is no clear traditional medical indication, is occasionally requested by women for a variety of personal reasons. International and Australian medical guidelines agree that this choice should be supported in well-informed women.

Fear-mongering with misleading statistics does not support the goal of empowering women with unbiased information, and may persuade against a desired birth choice.

We must also consider the effects that this messaging may have on those mothers who have already had caesareans.

For some, pressure to achieve a certain type of birth can be immense, and many women report feeling a sense of failure or disappointment after a caesarean birth. Incorrectly blaming caesareans for causing various childhood conditions is likely to contribute to this sense of disappointment and guilt.

An increased respect for maternal choice and autonomy means that a wide range of birth options are now available for women in Australia. The wide and wonderful variety of birth preferences reflects the wide and wonderful variety of birthing people that we care for.

There is no doubt that there are occasional serious risks as well as significant benefits to caesarean birth, just as there are occasional serious risks and significant benefits to vaginal birth.

Our job as maternity care clinicians is not to demonise one type of birth over another. It is to provide clear, factual and unbiased information, and support women as they apply this to their own unique pregnancy and birth preferences.