NSW birth policy ‘traumatising’ women with excessive forceps use

Two weeks overdue with a large baby on board, the first-time mum wishes she was offered a caesarean when things were not looking good, but Ms Hagan believes the push for a “normal birth” took precedence and her son had to be delivered by forceps as a result.

Not only was she torn “right through” with a third-degree perineal tear but she began haemorrhaging and was rushed to theatre for emergency surgery. Ms Hagan, of Newcastle, was also left permanently damaged with a prolapsed bowel, uterus and bladder.

April Hagan believes the push for a “normal birth” put her and her son’s life at risk. Picture: Sue GrahamSource:News Corp Australia

“I have to wear a pessary to stop my organs falling out. 100 per cent I should have had a caesarean, I was hugely overdue, my baby was over four kilos and I know now the damage that was caused by ripping my son out of me,” Ms Hagan, 28, said.


Last week in the UK, the Royal College of Midwives officially renounced their so-called “campaign for normal birth”, admitting the use of the word “normal”, and the pressure from midwives to resist medical interventions such as caesarean sections, had made some women feel like failures, and was contributing to post-natal depression.

The UK moves followed the preventable deaths of 11 babies and one mother who had died in one maternity unit. An independent report the influence of a small number of individuals were overzealous in pursuit of natural childbirth which led to “inappropriate and unsafe practice”.

Dr Hannah Dahlen, a Professor of Midwifery at the University of Western Sydney and an executive member of the Australian College of Midwives described the reporting of the Royal College of Midwives move as “fake news” in a tweet saying: “For all those UK midwives feeling hammered this week by Fake News remember ‘thinking is difficult which is why most people judge’.”

Dr Hannah Dahlen’s tweet.Source:Supplied

In Australia, Ms Hagan, and some experts, are beginning to question the Towards Normal Birth policy instituted by NSW Health in 2010 to reduce the state’s caesarean rate, which some midwives have argued is more expensive and has longer recovery times than vaginal birth. One in three women in NSW has a caesarean.

The policy aimed at “promoting normal birth” came with targets to increase vaginal birth to 80 per cent but experts say it has contributed to “an epidemic” in forceps deliveries.

“I felt they wanted him to come out the normal way not matter how much damage they did, but I now know 50 per cent of women who have a prolapse had (previously had) a forceps birth,” Ms Hagan said.


While the policy has failed to reduce caesarean rates, forceps deliveries have quadrupled at some hospitals, with one in 10 babies born at The Royal Women’s Hospital and Royal North Shore now delivered with forceps, a rate Hans Peter Dietz, Professor of Obstetrics and Gynaecology at Sydney University said is “among the highest in the world”. At the Royal Prince Alfred, forceps deliveries have risen from two per cent to eight per cent.

Next month, former Sydney mum Amy Dawes, who now lives in Brisbane, is launching the Australasian Birth Trauma Association to provide an online support forum for mums who have been injured from vaginal birth.

Ms Dawes, 33, had a forceps delivery at Royal North Shore three years ago. Her pelvic floor muscle was torn off the bone.

Amy Dawes’ daughter Eliya had a forceps delivery three years ago. Picture: SuppliedSource:Supplied

Ms Hagan believes she should’ve had a caesarean with her son being over four kilos. Picture: SuppliedSource:Supplied

“If I’d had a caesarean I would have felt I failed because we hear all the bad things about Caesareans but no one told me the risk of vaginal birth. I was not told of the risks associated with normal birth. I thought I was the only one but there are thousands,” Ms Dawes said.

Professor Dietz has called for a review into the Towards Normal Birth policy because “the ideology of vaginal birth at all costs” has led to obstetricians having less input in labour wards.

“In some instances that means obstetricians are called into too late,” he said.

“The focus on lowering caesarean rates has led to a marked increase in forceps delivery. The forceps rates at Royal North Shore (11 per cent) are some of the highest ever documented in large hospitals in Australia.”

Prof Dietz, who specialising in treating women with prolapse, has also questioned the targets of reducing caesarean rates by encouraging women to attempt a vaginal birth after caesarean, known as VBAC.

Prof Dietz said a study published on a VBAC clinic at St George Hospital documented two deaths he felt were unnecessary.

The study, which was published in the Australian and New Zealand Journal of Obstetrics and Gynaecology in 2014, showed that of the 160 women who attempted a VBAC, one in three eventually needed an emergency caesarean, one in five needed an instrument delivery and two babies died.

“One baby died when the uterus ruptured which is the standard complication with VBAC, we have known that for 100 years that is the risk of VBAC. The second baby died at 40 + weeks, a stillbirth that would not have happened if she had a repeat caesarean, which would have happened at 39 weeks. I do not think it can be disputed that VBAC caused the death of those two babies,” Prof Dietz said.

Ms Hagan wants Australia to follow UK’s lead and back off the push for a normal birth. Picture: Sue GrahamSource:News Corp Australia

Spokeswoman for the Australian College of Midwives Professor Jenny Gamble rejected the notion that doctors were sidelined saying “midwives and obstetricians work together to provide care, there is not a provision to lock them out”.

“What is really clear is there is a cascade of intervention, if you induce a woman, she has an epidural, there is clear evidence if these things flow through you are more likely to end up with forceps, vacuum or caesarean than a normal birth. It doesn’t stack up you are increasing forceps birth because you are trying to improve the number of women who give birth normally or vaginally,” Prof Gamble said.

But both Ms Dawes and Ms Hagan want Australia to follow the UK lead and back off the push for normal birth because of the judgement surrounding intervention.

“I’ve spoken with women who say they have trouble saying they had a caesarean, there is so much emphasis on how you birth the baby,” Ms Dawes said.

Spokesman for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Dr Vijay Roach said the focus needs to be on what the pregnant woman wants rather than ideology.

“There are two parts, safety and respect and we need to ask the woman what she wants and what is important to her. Obstetricians are risk adverse and some midwives have a tendency to believe birth should be intervention free. We don’t ask the woman enough what she wants,” Dr Roach said.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.