Home births and elective caesareans are on the rise as more women feel empowered to customise their births.

Christchurch midwife and midwifery adviser Jacqui Anderson said women were more confident about customising their births to suit their values and desires than they had been in the past.

"Labour and birth are physiological processes that don't change. It's only our practices that change around it.

"It's such a personal process: there's family history, your own personal experience your partner's experience and their family's history. It's not black and white. It's one of the most personal and life-changing all-encompassing experiences people will have."


Statistics provided by the Ministry of Health show elective caesareans have risen from 9.8 per cent in 2007 to 12 per cent in 2016. Data for 2017 was not yet available.

The number of home births had also increased a fraction from 3.2 per cent in 2007 to 3.4 per cent in 2016. However, district health board statistics show home births are more popular in some parts of the country.

In the Hawke's Bay DHB area, home births have risen from 1.9 per cent in 2013 to 4.4 per cent in 2017. The West Coast had a rate of 12.5 per cent in 2011.

Anderson said one of the biggest changes was women getting continuity of care in 1990. Before then, instead of having one assigned midwife, a woman might see more than 50 healthcare professionals over her medical visits.

"In the last 20 years, women have become more comfortable in being able to identify what they want and expect.

"[For midwives] it's much more about walking alongside the woman and her family as opposed to saying 'you're pregnant and these are the things you have to do'."

Sandy Grey has worked in midwifery since 1985 and agreed the biggest change was when midwifery regained its status as an autonomous profession in 1990. From that point more women came to see birth as a natural life occurrence rather than a sickness.

Auckland woman Sandy Grey has been working as a midwife, helping mums and their babies, since 1985. Photo / Supplied
Auckland woman Sandy Grey has been working as a midwife, helping mums and their babies, since 1985. Photo / Supplied

She blamed disproportionate coverage on traumatic births for many women having a fear around giving birth, pain and wanting to be in hospital.


"People think of birth as an emergency, life-threatening situation where they need to be in hospital, but in fact the majority of women birth well and fine; 80 per cent don't need anything at all."

Water births had become popular since the late 1990s, Grey said. But the most recent trend was encapsulating the placenta. The placenta is freeze dried, ground and put into capsules which the mother takes for the nutrients.

Grey estimated that had really picked up in the last five years, particularly within the Asian community.

Grey's advice to women was to birth in the environment you feel most comfortable in, with people you trust and want there. Having low stress will help the labour progress smoothly.

"The woman has to feel whatever is most right for her and where she feels most relaxed."

Anderson, who estimated she'd seen up to 2000 births in her 34-year career, said support for women who chose to home birth had increased dramatically. Two or three decades ago women used to be chided when they had to go into hospital after trying to give birth at home.

"Now it's 'okay, you need some extra help and here we are'. There's a much better atmosphere.

"It's about a birth being a much more personalised experience rather than something just done to a woman. You're not just a number."

In the last 10 to 15 years, hospitals had incorporated more friendly tools for women such as birthing rooms, pools and birthing stools. Using a birthing pool to provide pain relief during labour and birth was also common.

Anderson believed Maori culture had influenced all New Zealand women with the handling of the placenta. Many mothers opted to keep their placenta and bury it in a special place.

Anderson said there were benefits, backed up by evidence, that having a natural birth with minimal intervention was best for mother and child. However, some mothers had risk factors that meant the benefit of a caesarean outweighed that of a vaginal birth.

"Labour is an unknown quantity. You don't know how you're going to feel. And what you feel is right at the time. It's about options and flexibility," Anderson said.

"Women are quite hard on themselves ... In the end, a best outcome is a healthy mum and healthy baby."

New Zealand's record-low fertility rate shows women might also be having more control when it comes to getting pregnant in the first place.

Data from Statistics New Zealand showed our national fertility rate was down to 1.81 births per woman - the lowest level since records started in the 1920s.

The lower fertility rate could lead to reduced population growth if it stayed below the replacement level of about 2.1.

Read the four Kiwi mums' stories here.