A spike in emergency caesareans across Auckland is being partly blamed on a shortage of midwives.
Caesareans jumped 7.7 per cent in the past year at Counties Manukau District Health Board, and at Waitematā DHB they were up 10 per cent.
Almost all were "acute", or emergency, caesarean, as opposed to elective operations where the mother chooses a caesarean ahead of time.
In Counties Manukau, 28 per cent of women gave birth by caesarean in the 12 months to January, compared to 26 per cent the year before.
At Waitematā DHB, caesareans were at 33 per cent in 2017, up from 30 per cent in 2016. A spokesman said it was hard to say why the increase had happened without a thorough review, but it appeared most of the jump was in acute surgeries.
Auckland DHB did not provide the most recent figures but it is understood the DHB also experienced a significant increase in emergency caesareans last year.
Over the 2016/17 year, 38 per cent of births at the DHB's National Women's Health hospital were by caesarean, up from 36 per cent in 2015.
Across the three DHBs the spike represents at least 500 extra women who delivered by caesarean.
Nationally, about one in four women have their baby delivered by caesarean.
Counties Manukau's Health Advisory Committee heard in January that it was not clear what was behind the spike.
"The region will continue with data analysis and clinical discussion to understand what is driving the significant spike across the region," a report to the committee said.
"Midwifery (both LMC and self-employed) and junior medical staff shortages may well be a factor in this increase as well as the impact of new practice guidelines."
CMDHB spokeswoman Lauren Young said the increase was because of "increases in acuity and complexity of women birthing". New best-practice guidelines were encouraging more interventions - such as when babies' growth was restricted.
"In addition, patients (women and families) and staff have become increasingly risk-averse," Young said.
"Midwifery shortages may also be an influence."
In February midwives appealed to the Government to deal with a crisis in their sector, saying years of poor pay and long hours were contributing to a shortage of midwives. Pregnant women were struggling to find midwives in many parts of the country.
New Zealand College of Midwives midwifery advisor Alison Eddy said the college had heard "anecdotally" that caesareans were up nationally.
The most common reason for an emergency caesarean was a failure to progress in labour, Eddy said.
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"There's lots of evidence that supports the fact that women having one-to-one midwifery care in labour helps avoid caesarean. A midwife provides close monitoring of the woman, and if she's feeling safe and secure, her natural hormones will help things happen the way they should.
"If labour is long and slow, the woman's tired, the baby's tired and at some point someone says that a caesarean is the better option."
It was also possible the new guidelines were making doctors and midwives more risk-averse, Eddy said. At present "acute" caesareans are often a judgment call, rather than an absolute emergency.
Although it was good to have caesareans as an option, the increasing rate was "not ideal", Eddy said.
"Women are more likely to have a haemorrhage, be bedbound, need more pain relief, more surgery pain relief, have breastfeeding issues ... and big population studies show they're more likely to have a stillbirth subsequently."
Caesareans were also expensive, taking up operating theatre time and requiring a surgeon and anaesthetist and a longer hospital stay.
'I just wanted him out safely'
Amy Fraser wanted to give birth naturally but after more than a day in labour she knew it probably wouldn't happen.
Her baby boy, Rawiri Rain Fraser, was born by c-section at Auckland City Hospital's National Women's Health on February 1.
Rawiri was a big boy so Fraser, 30, was induced early. But despite contractions starting she wasn't dilating at all.
"My body was doing the work for nothing which was pretty discouraging," she said.
After a sleepless night, the contractions were getting so intense Fraser was vomiting from the pain. She finally reached 3cm and her midwife was called. She was taken to the theatre and given an epidural, but her body reacted badly.
"At this point I had been in labour maybe 25 hours...they said to get ready to start pushing. I said OK but I just had this feeling he wasn't coming that way," she said. "Then his heart rate started dropping. I was having contractions but every time I started pushing his heart rate dropped."
After trying to push for two hours she was taken to theatre.
"I was not quite with it but enough to know it was not good. All of a sudden his heart rate plummeted, and my blood pressure did too. They acted immediately and cut him out in less than three minutes."
Mum and baby are both doing great, although Fraser is still in recovery from her operation. Despite the stigma about mums who are 'too posh to push', c-section is not the easy way out, she said.
"No - it's really brutal. People just think they slice you and he's out - but you still bleed six weeks after, you can't drive, your stomach's full of staples. As a single mum, I'm really lucky I had family. Mum was there handing the baby to me at all hours of the night."
She still wishes she could have given birth naturally but is realistic about what happened.
"I wasn't one of those women with a laminated birth plan - I just wanted to get him out safely," she said. "The natural way is probably how it should be. But I also think if you want a c-section, it's your body, go for it. We should be in charge of those decisions."