Caesarean section--a woman's right to choose: ICM Central Europe Region workshop: regional representative Renske Drejer reports on a workshop held in Vienna, Austria, April 2004, to address an important issue for midwives.

• Auteur: Drejer, Renske

Midwives in the Central Europe Region, along with many others around the world in both developed and developing countries, are very much concerned about the ongoing increase of the Caesarean section rate.

Facts and figures about Caesarean section rates in the member countries of this particular region have been reported and are shown in Table 1. These data have been collected by midwives from their own national sources.

What can midwives do?

Knowing these figures, we asked ourselves what we can do to influence the phenomenon of rising CS rates within the region. It was decided to organise a workshop on the subject of Caesarean section: eventually this was arranged to he held in Vienna on 3rd April 2004. Twelve ICM delegates attended.

The subject 'Caesarean section' was considered too wide, so we chose a more specific theme: 'Caesarean section: a woman's tight to choose?'. Mary Sidebotham, a member of the Association of Supervisors of Midwives in the UK, offered her help and her skills as a workshop moderator.

The following questions, to which we hoped to find some answers, were selected as the guidelines through the workshop:

* Is the worldwide rise in the Caesarean section rate something we as midwives are concerned about?

* What are our concerns?

* Why is it happening?

* Are women concerned?

* Can we do anything about it?

Divided into two groups for discussion, we were given eight case histories to study, taken from a Dutch survey looking for obstetricians' views on elective Caesarean section.

Emerging from these histories were some of the reasons why certain women ask for a delivery by Caesarean section.

* Fear of perineal trauma

* Fear of fetal distress

* No motivation to choose a vaginal delivery

* Previous delivery experienced as very traumatic, pelvic pain

* Obesity

* Previous elective Caesarean section because of a not engaged breech: now afraid for uterine rupture.

The groups were asked to identify what empowered midwives could do in each of the cases to help the women to make their decision. Two important conclusions were among those reached after the discussions were:

* In discussions with obstetricians, midwives need to be well informed about actual research findings.

* Midwifery teachers must ensure that the new members of the profession learn the essence of their job: being with women and being pro-active in supporting normal birth.

Action plan

We agreed on the following action plan:

1. To write a new position paper for ICM...