Empowering Birth: The Rise of Maternal Assisted Caesareans in Australia

For many Australian women, the journey of childbirth doesn’t always unfold as planned. For one mother, her first experience with a caesarean section was far from the empowering moment she had envisioned. Facing a breech baby and unsuccessful turning attempts, she found herself on the operating table, a spectator to her own child’s birth. “I lay there, paralysed on the operating table in a cold and brightly lit theatre, surrounded by a dozen very busy strangers,” she recounts. “It was the most momentous day of my life, but I felt powerless, uninvolved and, quite frankly, a little irrelevant. Surely, my role in the birth of my child was more than just lying down and listening to the obstetrician’s playlist?”

The immediate aftermath of her first child’s birth was equally disorienting. The newborn was quickly taken away for assessment, leaving the mother, still groggy from anaesthesia, in the dark about her baby’s well-being. For the next 12 hours, she remained largely unconscious, while her partner was left to bond with their son.

Fast forward two years, and the same woman found herself back in an operating room for her second child’s birth, again via caesarean. This time, however, the experience was profoundly different. She describes feeling “empowered and involved, having just played an integral part in the most deeply moving experience of my life.” Her baby was placed directly onto her bare chest, nuzzling her neck and beginning to breastfeed even before she was wheeled out of surgery. The key to this transformative experience? A maternal assisted caesarean (MAC).

What is a Maternal Assisted Caesarean?

A maternal assisted caesarean, as explained by Sydney-based obstetrician Georgina Davis, is a thoughtful modification to the standard caesarean procedure. It’s designed to allow the mother to play a far more active role in the birth of her child.

• Active Participation: The mother, after surgically scrubbing in, is guided to lift her own baby from the womb directly onto her chest.
• Immediate Skin-to-Skin Contact: This allows for instant and crucial skin-to-skin contact, fostering bonding and regulating the baby’s temperature and vital signs.
• Empowerment and Satisfaction: Davis highlights that the primary benefits of MAC are “maternal satisfaction and walking away from birth feeling completely empowered and in control.” For women who have experienced previous traumatic births, MAC can offer a significant healing opportunity.

The Disconnect: MAC’s Underutilisation in Australia

Despite the clear benefits, the maternal assisted caesarean is far from a standard offering in Australian maternity care. With a significant 41 per cent of Australian mothers giving birth via caesarean, the fact that MACs are not universally available is a point of concern for many.

Several factors contribute to this underutilisation:

• Lack of Familiarity: Ballarat-based obstetrician Lachlan Brennan believes that a significant hurdle is simply “unfamiliarity with MACs.” He notes that once key medical professionals are educated and on board, they are generally receptive to the concept. This involves comprehensive background work with anaesthetic, paediatric, and theatre staff to ensure everyone understands the procedure and its smooth execution.
• Varying Awareness of Birth Experience Importance: While obstetricians and midwives are increasingly recognising the profound impact of the birth environment and experience on women, other hospital staff may not share the same level of awareness. This can lead to a lack of support for procedures like MAC that prioritise the mother’s emotional and psychological well-being.
• Concerns Over Sterility: A primary concern raised by hospitals, according to Davis, revolves around maintaining sterility. “The main thing that we hear is, ‘surely there’s going to be more risk of infection for both the mother and the baby’,” she states. However, Davis has not encountered evidence to support these fears.
• Focus on Clinical KPIs vs. Maternal Satisfaction: Davis points out a critical disconnect in hospital priorities. “Maternal satisfaction and wellbeing is not a KPI, while a surgical site infection and admission to the special care nursery is,” she explains. This means that while the emotional well-being of the mother is paramount for her recovery and long-term health, it often takes a backseat to quantifiable clinical outcomes.

The Case for MAC as Standard Practice

The birth experience is a deeply significant event, and its impact on a woman’s overall health and well-being is undeniable. In a country where a substantial number of mothers describe their births as traumatic, there is a clear need to enhance positive birth experiences. Maternal assisted caesareans hold significant promise as a way to achieve this within the caesarean birth sector.

For MAC to become a more widespread option, several steps are crucial:

• Increased Research: More dedicated research into the safety and efficacy of MAC procedures is needed to address lingering concerns about sterility and potential risks.
• Enhanced Education and Awareness: Comprehensive training and awareness campaigns for all healthcare professionals involved in caesarean births are essential to demystify MAC and promote its benefits.
• Open Discussion: Encouraging open dialogue between expectant parents, obstetricians, and hospital administrators about the possibility and advantages of MAC is vital.

Ultimately, maternal assisted caesareans should be a standard offering for any woman who meets the necessary medical requirements, irrespective of her chosen obstetrician or hospital.

The experience of mothers like the one who shared her story underscores the profound difference MAC can make. It transforms a potentially passive and impersonal surgical procedure into a deeply meaningful, healing, and active birth experience. Every mother and baby deserves the chance to experience childbirth in such a positive and empowering way.