It wasn't until Caringbah mum and midwife Lauren Brenton was pregnant with her fourth child that she realised she wanted a different birthing experience.
Having had an elective (breeched) caesarean for her first baby at age 18, a second emergency caesarean, followed by another elective caesarean, she felt slightly disconnected from the labours.
"I loved my babies but I felt like there was something missing. I missed that big moment that so many women get when they get their baby onto their chest," Mrs Brenton said.
But in April, when Wilder was born, she had the birth of her dreams - and was the first woman to have a maternal assisted caesarean at Kareena Private Hospital.
During the procedure, the mother, who has been surgically scrubbed, helps 'deliver' the baby. There is no blue screen to shield her view, and wearing gloves, the mother's hands are guided underneath the baby's shoulders once its head has emerged, and she lifts the baby directly onto her chest.
Mrs Brenton, who works at the hospital, wrote the policy in conjunction with the maternity team in March 2022 for the procedure to be implemented at Kareena. Since Wilder's birth, there have been about 20 maternal assisted caesareans.
"It's about empowering women and helping families to know there are different options," she said.
The midwife also conducted a survey of more than 2000 women who have had a caesarean. "When I compared how people felt during and after their caesarean, the results were outstanding," she said. "Eight per cent felt disconnected with a maternal assisted caesarean compared with more than 50 per cent who had a regular caesarean.
"The rates were also very different in terms of separation from the baby and skin-to-skin. A total of 13 per cent of women who didn't get skin-to-skin straight after birth had medical concerns, and 60 per cent didn't get skin-to-skin with a normal caesarean."
Mrs Brenton started to promote her work on Instagram, not long after the start of COVID-19. "I noticed there was a large gap in families coming into the hospital system who didn't have enough education - they were scared," she said. "Antenatal classes were cancelled, and I wanted to give families somewhere they could turn to for accurate information, rather than just surfing through Goggle."
But advocating for more maternal assisted caesareans wasn't easy. "It was hard work - I got a 'no' left, right and centre," she said. "People would say 'why do you want to do that? you just want to be like the Kardashians.' There still is judgement about birth choices. It's a shame because everyone comes into birth with such difference life experience. I had an older midwife say I hadn't really given birth. You can have these beautiful caesareans and not feel like you've done the wrong thing."
Caesarean section rates have increased steadily worldwide in the past decade in most OECD countries. In 2021, 38 per cent of all women giving birth in Australia had a caesarean section, compared with 32 per cent in 2011.
Mrs Brenton's obstetrician at Kareena Private Hospital, Andrew Zuschmann, who was the first to perform the procedure at the hospital, said there was a lot of planning involved to enable women to have the procedure.
"We needed to engage full departments - anaesthetists, theatre nurses, and we had to get the hospital executive on board to sign it of before we developed the policy. It required broad engagement to get this across the line to be able to offer it," Dr Zuschmann said.
"It's a fairly new procedure. Before Lauren's it was not really spoken about much widely. There was some talk about 15 years ago, when somebody in the UK wrote up a procedure called a natural caesarean where you get the baby's head and arms out and let the bub kind of crawl out, but that didn't really gain a lot of traction. It didn't give people the experience they were after.
"Forever women have been having vaginal births - quite often we would get the women to reach down and grab bub up. Being able to engage people in their own birth has been fantastic, but it's certainly not for everyone. For some women it's very empowering to know it's even an option for them and get more engaged in their own birth."
The World Health Organisation states the trend in rising caesareans in general, has not been associated with significant maternal or perinatal benefits.
Dr Zuschmann says while there hasn't been proven research to show that maternal assisted caesareans was medically more beneficial for babies, there are promising signs.
"If you put maternal assisted caesarean into any medical data base you get zero results. What we do know, is that immediate skin to skin after birth is important and does improve breastfeeding outcomes and bonding with the mum and the baby," he said. "We can offer immediate skin to skin which is a little bit harder to do with as standard caesarean. That has proven benefits and we are hopeful over time it will develop more research.
"There is a lot of interest in women's birthing experiences as a whole, particularly in NSW at the moment with the Birth Trauma Inquiry. Any way that we can engage people in their birth and improve their birthing experience is going to have benefits that we can really measure."
He said patients who had a maternal assisted caesarean reported it is an overwhelmingly positive experience. "Those who choose it are highly motivated to be involved in their own birth," Dr Zuschmann said. "To introduce something into our community that gives people options, I'm very pleased I was able to do the first one in the area."
