1. 32% of all births were via c-section

The latest data available in New Zealand is the statistics from 2022. In that report it noted that c-section birth rates have increased over the last 15 years to 32% of all births in 2022, the highest ever recorded. Of the c-section births in New Zealand, roughly half (10-15%) are elective/planned and the other half are emergent/not planned. Common reason for having an elective c-section birth are medical necessity (for example, breech presentation, placenta previa, previous c-sections, or pre-existing medical conditions), multiple pregnancy, or personal maternal request. 

2. By 2030 c-section births could make up 45% of births

According to the World Health Organisation, worldwide c-section rates have risen and are projected to continue increasing over this current decade. Causes of higher c-section births vary widely between and within countries. Drivers include health sector policies and financing, cultural norms, perceptions and practices, rates of preterm births, quality of healthcare, and more advanced maternal ages. If this trend continues, by 2030 the highest rates are likely to be in Eastern Asia (63%), Latin America and the Caribbean (54%), Western Asia (50%), Northern Africa (48%), Southern Europe (47%), and Australia and New Zealand (45%), the research suggests. 

3. A c-section birth is not easier

Birth is birth. No one way is harder or easier than the other, everyone’s experience is individual and different. However, something that is often overlooked with a c-section is that it is major abdominal surgery. It requires a surgical incision through 7 different layers of tissue. A procedure, that is performed in theatre, requiring at least one obstetrician, an anaesthetist and assistant, a surgical assistant, two nurses, a paediatrician, an orderly, your midwife and support person – all important in ensuring the safety of you and your baby. Post birth, it is common for recovery to take a minimum of 4-6 weeks and it is often not painless or easy. Birth is not for the faint-hearted, it takes a strong women to deliver a baby safely into the world. 

4. You can have skin to skin contact with your baby

While a c-section birth is also considered a sterile surgical procedure, you can still have immediate skin-to-skin contact with your baby if both you and baby are healthy and stable, and it’s safe to do so. This is something you should mention to your LMC prior to delivery so they are aware of your preference in the delivery room. At the very least you should be able to have skin-to-skin contact once your baby has been checked by your doctor or midwife. 

5. Midwives get paid less for an elective c-section delivery

If a woman has an elective c-section birth (doesn’t labour), the midwife still gets a fee, the midwife is still paid. However, that midwife does not receive as much as she would if she looked after a woman in labour for a number of hours and then had a vaginal or emergency c-section birth. More generally, the College of Midwives (on behalf of LMC’s) recently brought legal action against the Government in a bid for fair and reasonable pay and a change in contract model. Representing the midwives was leading law firm Tompkins Wake and Thornton Chambers. This six week trial concluded late last year and judgment is still pending.

6. Requesting a c-section birth is not a choice women can make freely or openly

While a c-section birth on request is legal, it is not in New Zealand a choice women can make freely or openly without either paying for a private obstetrician (upwards of $7,000) or getting medical approval/sign-off. It is not a midwife’s role to decide if a woman does or does not get to have a c-section birth, the procedure can only be signed off by an obstetrician and it usually requires a valid medical reason for doing so (the Ministry of Health does not collect clinical data on how many people ask for, or undergo, a c-section birth by maternal request). A reason given for this limiting freedom of choice is that the New Zealand health system would not currently cope, lack of beds and staff contributing to this, not to mention the financial strain. However, British research suggests that once vaginal birth injuries are accounted for, the cost difference between a vaginal birth and a c-section birth are minimal. The UK made maternal request c-section births free via the public system in 2011, it is argued that New Zealand should follow that example.

7. There is now specific c-section support

Until recently, this was sadly not the case or at least the support options weren’t widely known or accessible. However, today there are many great options. To name a couple:

-At-home postpartum products. There are now some great healing options for managing your c-section recovery at home. Firstly, premium 100% medical grade silicone by Myscar is excellent for improving your scar’s healing and appearance. These silicone strips reduce moisture loss, regulates collagen production, and generally relaxes the scar and surrounding skin making your scar a more invisible fine line. A c-section scar release kit, is helpful for reducing the commonly known c-section ‘shelf’, skin overhang that sits above and over your scar.  Abdominal support, such as a tubigrip/belly band or high waisted underwear can offer you the extra support you need to ease mobility particularly if the first few weeks. Also, heating/cooling packs and hypercal (a soothing lotion with natural antiseptic) are beneficial in relieving pain and discomfort you may experience. Finally, there are various creams/oils that can be applied to aid you in your scar massage once your incision has fully closed/healed. 

-Pelvic Health Physios. Pelvic floor physiotherapy following birth can be a beneficial part of your recovery, including helping reduce pain and improve mobility, function and quality of life. Women who have had a c-section delivery can experience restriction of the tissue around their healing incision. This can lead to pain and limited function. Although many of these impairments are common, they are not normal and you shouldn’t have to put up with them. Seeing a pelvic health expert can get you a thorough evaluation to assess the function of all these tissues. There should be a pelvic health physio/expert near you, some examples are Auckland Physiotherapy (Auckland), Tiaki Pilates & Physio (Wellington), Positive Pelvic Health (Wellington) Elevate Physio (Nelson), The Pelvic Physio (Queenstown).

-Scar release massage experts. After a c-section birth it is common to have overhang that sits above and over your scar (commonly known as a ‘shelf’ or ‘pouch’). A shelf occurs when the various layers of healing tissue along the incision adhere to one another, and therefore, the scar becomes indented and the tissue just above the scar can puff out. This can be uncomfortable and can also cause insecurity for some women. Seeing a c-section/general scar release massage expert is a great way to seek further support with your caesarean scar management. They will they be able to throughly massage the scar and improve your shelf, but also give you specific scar massage techniques to do at home. The Waiora Collective (Porirua) and My Beauty Room (Auckland) are just two examples of businesses that offer this type of scar support. 

8. 100% medical grade silicone is a proven, safe, and effective way to help scar healing

Medical grade silicone for scar treatment has been clinically researched, tested and proven to be effective in the reduction of both abnormal scar formation (keloid/hypertrophic) and exisiting scars (new and old). It has been used for over 30 years, notably in Europe/UK, and is commonly used in hospitals for burn patients. Not surprisingly, silicone is mentioned as a preferred non-invasive therapy in all current International Scar Management guidelines. New Zealand owned company, Myscar, specifically designed and manufactured premium medical grade silicone to assist mothers in their c-section scar recovery (which was a NZ first, prior to this premium silicone was inaccessible to the NZ market, particularly for c-section scars). 

It is important to note that 100% medical grade silicone is classified as a medical device, it is legally required to be medically registered in most countries. Be extremely weary of products seen online from overseas vendors or other websites selling silicone at extremely cheap prices. Silicone is safe, non-invasive, and effective if what you are buying is in fact 100% medical grade silicone that has all the required legal and medical approvals and been manufactured to a high standard. It goes without saying that all Myscar products have all the appropriate registrations and approvals in New Zealand, Australia, America and Europe.

9. Having a previous c-section birth does not mean subsequent births have to be via c-section

Having one c-section birth doesn’t automatically mean all subsequent births will have to be via c-section delivery. Many woman can have a safe vaginal birth following a previous c-section birth (commonly known as a VBAC). When considering a VBAC, your previous pregnancies and medical history are important factors that will need to be taken into account including, the reason you had a c-section delivery. Generally the statistics of having a VBAC are in your favour, and you should be able to find an LMC that is encouraging of a VBAC if this is your preference.  

10. There are a range of services throughout the country designed to help you

After you have had a baby you will generally feel a rollercoaster of emotions. This is largely due to the cocktail of postpartum hormones circulating your body – progesterone, oestrogen, oxytocin, prolactin, adrenaline to name a few. Not to mention you now have a newborn baby in your arms, which comes with its own challenges and may include feeding and lack of sleep which can elevate stress (cortisol) levels. Then of course you have the physical recovery of a c-section birth, which is major surgery. Whether a c-section birth was your birthing choice or not, you may also feel disappointed with the way in which your birth went. It is A LOT, and for some it can be too much and that is OK. Speaking to your LMC regularly about how you are feeling is encouraged. They should be a safe space and excellent first port of call. Should you need additional help, New Zealand has a range of services throughout the country to assist you. For example, Mother Craft and Plunket (via phone & family centres). Mothers Matter is also a helpful resource, their mission is for better health and well-being outcomes for new mums, baby and wider family.