Record number of Victorian mums giving birth via C-section as caesarean rate reaches 42.6 per cent

The number of Victorian mums giving birth via C-section has reached a record high, with the caesarean rate almost doubling since 2000. Here’s what experts say has changed.

A record proportion of Victorian mums are giving birth via C-section, after the caesarean rate reached a high of 42.6 per cent.

The latest figures, for 2023, show caesarean rates have continued their steady rise, up from 40.9 per cent in 2022 and 33.33 per cent in 2013.

They have almost doubled since 2000, when just under a quarter of women delivered their baby via C-section.

A record proportion of Victorian mums are giving birth via C-section. Picture: iStock

Experts say increasing maternal age, rising levels of obesity and other health issues, a lower tolerance for risk and an increase in mums requesting caesareans have all contributed to the rise.

The figures were detailed in a report by the Consultative Council on Obstetric and Paediatric Mortality and Morbidity, an advisory body to the Victorian Health Minister.

CCOPMM chair and Victorian maternity task force co-chair Professor Mark Umstad said the increase was in both caesareans for medical and non-medical reasons, known as ‘maternal request’.

“There’s a complexity of medical conditions now where a generation ago many of these women would never have thought of having a baby,” he said.

“Now they are, and they’re having them successfully, but these are very complex and very high-risk pregnancies and it’s often — not always but often — a preference of both mother and clinician to deliver the baby via caesarean.”

He said caesareans were also “much, much” safer now than they were a decade or two ago — meaning the risk versus benefits scale may tip in their favour for more cases — and both patients and clinicians tolerated less risk.

“Over the last 10, 20 years the acceptance of risk is significantly less than it was,” he said.

He said fear of birth trauma — which they are working to address — was a big driver of maternal requests for C-sections.

“We saw from the New South Wales Birth Trauma Inquiry that one in three women report birth trauma, which is a horrific number and completely unacceptable,” he said.

“We’ve listened to women and we’re acting on that.”

But the Australian College of Midwives — while not commenting on the rise in maternal-requested caesareans — was critical of the number of medically indicated caesareans.

It’s often a preference for both mother and clinician to deliver the baby via caesarean. Picture: iStock

ACM midwifery advisor Kristy Watson said despite more woman undergoing them, outcomes were not improving.

“This rise in caesarean section rates, which is now for Victoria the second highest rate of caesarean sections in the country, is not coinciding with an improvement of outcomes,” she said.

“Particularly for Victoria, the perinatal mortality rates, which is referring to stillbirths and early death of newborns, that is also rising.

“The number of women being admitted to the ICU is not improving.

“We’re not improving the health and outcomes of women and babies through doing more caesarean sections.”

Dr Nisha Khot says a ‘major’ factor in the increase is the rise in women requesting to have a caesarean. Picture: Mark Wilson

She said the system’s ability to “wait and hold back on unnecessary interventions” was becoming lost in our typical maternity system and midwifery-led care — which has lower caesarean rates — needed more investment.

“The medicalised approach to childbirth is seeing more and more perception of risk, and a medicalised approach to want to intervene sooner,” she said.

But Royal Australian and New Zealand College of Gynaecologists and Obstetricians president Dr Nisha Khot said increasing obesity levels and maternal age meant more women were presenting with conditions that placed them at higher risk.

“For example if you have diabetes, you’re more likely to have a baby that’s bigger than average, so that might be a reason to recommend a caesarean section or for a woman to choose a caesarean section,” she said.

“We are seeing fewer and fewer pregnancies that can be described as the typically low risk pregnancies.”

The report says the average age for a first-time mum in 2023 is 31-years-old. Picture: iStock

The CCOPMM report stated the average first-time mum in 2023 was 31-years-old, compared to 29 in 2005, and 25 in 1985.

It also showed 52 per cent of women who gave birth in 2023 had a high BMI, compared to 44.3 per cent in 2015.

Dr Khot said a “major” factor in the increase was the rise in women choosing — and clinicians respecting that decision — caesareans.

“Women are now realising they have choice in both the private and public sector,” she said.

“I think for a long time women didn’t realise that there was a choice.

“It was a default that they had to have a normal birth unless they needed a caesarean section for some reason.”

She said the risks and benefits of caesarean depend on many different, individual factors, from a women’s medical history to the number of children she wants to have, so detailed, informed consent is important.

“We need to have those discussions individually with the person who is in front of us,” she said.

“By and large having a caesarean in Australia is safe.”

Originally published as Record number of Victorian mums giving birth via C-section as caesarean rate reaches 42.6 per cent