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April is Caesarean Awareness Month: Highlighting Australia’s Caesarean Section Trends
April is Caesarean Awareness Month – a time to reflect on how this major abdominal surgery has evolved and what it means for birthing women today, especially here in Australia where caesarean rates are among the highest in the developed world. It’s a moment to consider not just the statistics, but the stories, history, and shifts in maternity care that have led us here.
Unfortunately, the most recent publicly available national data for Australia only extends to 2022, and updates up to 2023 should be available mid-2025. However, in Western Australia, we also have access to the WA Mothers and Babies Report, which includes more up-to-date figures. This report provides a snapshot of birth statistics for both the most recent quarter and the full year. According to this report, the caesarean section rate in WA for 2024 was 43.2%. Other states and territories may also have similar reporting systems that offer more current data at a local level.
Some interesting history around caesareans
Caesarean births aren’t a modern invention – they’ve been documented as far back as ancient Roman times. In fact, the term caesarean is often (mistakenly) believed to be linked to Julius Caesar, though there’s no historical evidence he was born this way.
In ancient times, caesareans were usually performed post-mortem, to save the baby when the mother had died in labour. It wasn’t until the 19th century, with the introduction of anaesthesia and antisepsis, that maternal survival during caesarean became more common.
The Sushruta Samhita, an ancient Sanskrit medical text dating back to around the 6th century BCE, is among the earliest known documents to describe surgical techniques, including procedures resembling caesarean sections. Attributed to the physician Sushruta, this compendium details various surgical practices and instruments, indicating a sophisticated understanding of surgery in ancient India.
In 1879, a Scottish man named James Barry is often credited with performing one of the first successful caesareans in Africa where both the mother and baby survived. Remarkably Barry was born Margaret Ann Bulkley and lived as a man to pursue a medical career at a time when women were barred from the profession. This operation was a significant medical achievement, especially considering it occurred before the advent of antiseptics and modern anaesthesia.
The chainsaw was actually invented in the late 18th century (around the 1780s) by two Scottish doctors, John Aitken and James Jeffray, but not specifically for caesareans, but it was created to assist in symphysiotomy, a surgical procedure to widen the pelvis during obstructed labour by cutting through the pubic symphysis (the joint at the front of the pelvis). It was never intended for cutting through the abdomen or uterus as in caesarean surgery – but rather to aid vaginal birth by cutting bone when labour was obstructed.
Before this, the procedure was done using a knife – and as you can imagine, it was slow, excruciating, and dangerous. The early version of the chainsaw was a small, hand-cranked tool with a chain of serrated teeth, not unlike a modern-day chain on a bike, and it made this gruesome procedure faster and more precise.
Eventually, the medical use of the chainsaw fell out of favour as safer surgical techniques and anaesthesia improved, and the tool was adapted for use in orthopaedic surgery, and much later for cutting wood – the function most people associate with it today.
In 1876, Italian obstetrician Eduardo Porro introduced a revolutionary surgical technique combining caesarean section with hysterectomy to prevent postpartum haemorrhage and infection. This procedure, known as the “Porro operation,” significantly reduced maternal mortality rates associated with caesarean deliveries at the time. Porro’s method laid the groundwork for modern obstetric surgical practices.
The first successful caesarean in Australia where both mother and baby survived was recorded in the late 1800s, though it remained a last resort well into the 20th century.
Caesarean Section Rates in Australia
In 2022, 39% of all women giving birth in Australia delivered via caesarean section, up from 32% in 2010. For first-time mothers, the rate was even higher at 41%.
There are several reasons why Australia’s caesarean rates are increasing:
It’s also worth noting that many women are not given genuine choice about birth options after a previous caesarean, with VBAC often discouraged despite evidence showing it is a safe and reasonable option for most.
Key insights include:
Private vs. Public Hospitals: Caesarean rates were higher in private hospitals (46%) compared to public hospitals (31%).
Repeat Caesareans: Among mothers with a previous caesarean, 76% had a repeat procedure, making it the most common reason for subsequent C-sections.
VBAC (Vaginal Birth After Caesarean): In 2022, only 12% of women had a vaginal birth after a previous caesarean, with higher rates in public hospitals (15%) compared to private hospitals (5.3%).
WHO Recommendations on Caesarean Rates
The World Health Organisation recommends that caesarean section rates should ideally be between 10–15%, noting that rates higher than this are not associated with lower maternal or neonatal mortality. While WHO recognises that access to safe caesarean birth is vital, it also warns against its overuse in the absence of clear medical indication.
Understanding the Implications
While caesarean sections can be lifesaving, unnecessary procedures may pose risks:
For Mothers: Increased chances of infection, haemorrhage, and complications in future pregnancies
For Babies: Higher likelihood of respiratory issues and other complications, especially if delivered before 39 weeks gestation.
It’s also important to acknowledge the emotional and psychological toll an unexpected or unwanted caesarean can have, particularly when women feel they weren’t fully informed or supported in their decision-making.
Factors Influencing High Caesarean Rates
Several elements contribute to Australia’s rising caesarean rates:
Tools for Monitoring and Improvement
To better understand and manage caesarean rates, the WHO recommends the Robson Classification System. This tool categorises women into ten groups based on obstetric characteristics, aiding in the analysis and comparison of caesarean rates across different settings.
https://www.who.int/publications/i/item/9789241513197
Informed choice
As Australia continues to see high caesarean rates, it’s crucial to balance medical necessity with informed choice. Healthcare providers and expectant mothers should engage in open discussions about birth options, considering both the benefits and risks associated with caesarean deliveries.
Birth choices should never be about hitting a target or sticking to a guideline. Caesareans are an important part of modern maternity care – but they should be reserved for when they are medically necessary, not just routine.
This Caesarean Awareness Month, let’s call for:
If you’ve had a caesarean whether that was planned or unplanned, your experience matters. Your story adds to the bigger picture of how we can support women more holistically through pregnancy, birth, and postpartum.
Let’s make sure Australian maternity care isn’t just about getting the baby out safely but about supporting the whole woman every step of the way.
Resources:
Australia’s mothers and babies, Summary – Australian Institute of Health and Welfare
Australia’s mothers and babies
Australia’s mothers and babies, Method of birth – Australian Institute of Health and Welfare
National Core Maternity Indicators, Caesarean section – Australian Institute of Health and Welfare
WHO Statement on Caesarean Section Rates
The Extraordinary Secret Life of Dr. James Barry | HISTORY
https://en.wikipedia.org/wiki/Sushruta_Samhita
https://pmc.ncbi.nlm.nih.gov/articles/PMC3039177/
https://pubmed.ncbi.nlm.nih.gov/7988923/
https://en.wikipedia.org/wiki/Edoardo_Porro
Fact Check: Why Were Chainsaws Invented? | IFLScience
Symphysiotomy: The Brutal History Of ‘Chainsaw Childbirth’
https://vickihobbs.com/other-services/positive-caesarean-birth/
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
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