What makes physiological birth so hard?

I often talk about physiological birth being an endangered activity. By the estimation of midwives I’ve spoken to in Australia, physiological births that unfold without intervention in our hospitals make up between 1 and 5% of all hospital births. (While births in settings where you would expect physiological birth would be occurring, such as at home, in a birth centre, or ‘born before arrivals – think the back seat of the car – only make up around 3% of all births.)

But it’s not just Australia where the statistics are concerning for anyone hoping for physiological birth. Caesarean births, for example, are rising worldwide. In England, 42% of all births are now by caesarean section compared with 29% five years ago.

High caesarean rates in other countries (based on 2021 figures reported in 2024) include Turkey (58.4%), Brazil (56.4%), South Korea (53.8%), Mexico (52.6%), Ireland (35.5%), Vietnam (34.4%), Italy (32.3%), US (32%), Germany (30.7%), Canada (29.8%), Aotearoa New Zealand (29.6%).

Locally, the most recent Australia’s Mothers and Babies report (as well as reporting an increase in our caesarean rate) included a new field of data. The ‘selected women’ cohort are between 20 to 24 years of age, birthed at term and had a single baby, with ‘head down’. They are a ‘cohort of mothers who are expected to have reduced labour complications and better birth outcomes’. Comparisons between these ‘selected’ groups of women ‘allows for an indication of standard practice’.

Just looking at this cohort (for first babies born in 2004 compared to 2022), rates of induction have increased from 25.9% to 43.0%, caesareans have increased from 24.5% to 34.5%, and non-instrumental vaginal birth have decreased from 53% to 42.5%.

Research suggests that the majority of women want a physiological birth — a ‘natural birth’. The stats show us just how rare this is, not just in Australia but in so many settings around the world.

In my books I talk about the complex causes behind these stats, and the emotional and relationship dynamics readers need to be aware of that will affect their labour and birth in these care settings. But the key message I always have for my readers is not to see those statistics and think there is something wrong with our birthing bodies. What makes physiological birth so hard isn’t usually the birth process itself. It’s how we have come to support it (or not).

Read those stats as evidence that the care you need for physiological birth is not standard practice. Read those stats as a warning of what you are up against.

Really take in those stats as a first step. The next steps are those choices required to claim the birth you want.