In recent years, Australia has seen a rise in cesarean section rates. In 2021, one third of women giving birth for the first time did so via cesarean section, compared to one quarter in 2004.  The World Health Organisation advocates for a cesarean rate of between 10% and 15%, yet in Australia, rates have surged to well above this recommended range. These figures have prompted healthcare professionals and policymakers to re-evaluate current maternity care practices. While cesarean sections are essential for certain medical conditions, there is a growing concern that many are performed without clear medical necessity. This trend not only impacts maternal and neonatal health but also significantly burdens the healthcare system.

Midwives are uniquely positioned to influence this trend. The midwife-led care model centres on the belief that childbirth is a normal process and aims to empower women through minimal medical intervention unless necessary. Programs such as the Midwifery Group Practice (MGP) have shown promising results in terms of both maternal satisfaction and clinical outcomes. These models allow women to receive consistent care from a single midwife or a small team of midwives, enhancing the trust and relationship between the caregiver and the mother, which is essential for a positive childbirth experience.

The adoption of midwife-led care models has been associated with lower intervention rates, including reduced usage of epidurals, fewer episiotomies, and importantly, a decrease in cesarean sections.

A 2020 study found that low-risk women who attend midwifery-led services, have a low caesarean section rate. This was achieved with continuity of care, good antenatal preparation, and support throughout labour and birth by a dedicated tea.

Another review by the Cochrane Database of Systematic Reviews, which included several Australian trials, supports these findings, highlighting that women in midwife-led care settings are less likely to undergo episiotomy or require regional anesthesia.

Midwife-led care offers benefits that extend beyond reducing cesarean rates. The approach fosters a supportive, empowering environment that can lead to more positive childbirth experiences.

Physically, women under midwife-led care are more likely to experience natural childbirth with fewer interventions, such as episiotomies or the use of forceps. This can lead to quicker recovery times, less postpartum pain, and lower rates of infection or complications arising from surgical interventions.

Psychologically, midwife-led care contributes to greater maternal satisfaction. Women report feeling more in control of their birthing process and more supported in their choices. This perceived control can reduce the incidence of postnatal depression and anxiety, leading to better overall mental health during the postpartum period.

One of the most significant benefits of midwife-led care is the continuity of care, where the same midwife or small team of midwives supports a woman throughout her pregnancy, during birth, and in the postnatal period. This trust and understanding, allowing midwives to tailor care to the individual needs and preferences of each woman. This can lead to a range of improved outcomes, including:

• Lower rates of preterm births.
• Fewer birth interventions.
• Higher rates of maternal satisfaction.
• Increased likelihood of giving birth with a skilled attendant present.

In a study conducted in Queensland, women who received continuity of care from a midwife were less likely to have a cesarean and reported feeling more prepared for labour and delivery, with a stronger sense of safety and satisfaction. This sense of security can significantly impact labour progression, often leading to shorter labour durations and reduced need for pain relief.

While midwife-led care has many benefits, there are significant challenges and systemic limitations. One of the primary challenges for midwives in reducing cesarean rates is the medicalisation of childbirth. In many settings, there's a cultural and institutional bias towards obstetric interventions, which can limit midwives' ability to advocate for less interventionist approaches.

Communication barriers between healthcare providers can also complicate the delivery of consistent, midwife-led care, especially in complex cases where multiple specialists are involved. These barriers can lead to inconsistencies in care approaches, potentially increasing the likelihood of interventions such as cesareans.

Systemic limitations also play a significant role. Hospital policies that favour quick turnovers and manage risk aggressively can lead to a higher likelihood of scheduling cesareans. For example, limited access to resources like labour rooms or staffing constraints can pressure healthcare providers to opt for cesareans, which are often perceived as more manageable. Addressing these issues could support more widespread adoption of midwife-led care and contribute to a reduction in unnecessary cesarean sections.

Through midwife-led care, we see a model that supports the physiological processes of childbirth and significantly enhances maternal and neonatal outcomes. This care model reduces medical interventions, fosters a supportive and empowering environment for mothers, and results in higher satisfaction rates and better overall health outcomes. To move forward, it is essential that healthcare professionals and policymakers actively work to integrate and support midwife-led models within all care settings. As we look to the future, let us advocate for a healthcare system that fully recognises and utilises the expertise of midwives, ensuring that more women have access to the benefits of midwife-led care. By doing so, we can take significant steps towards reducing cesarean rates and improving the quality of care provided to mothers and children across Australia.