Dr Kerryn Phelps, AMA President, 'Today', Channel Nine

To discuss the pros and cons of natural delivery and C-sections, we're joined in the studio by Today health editor Dr Kerryn Phelps.

Good morning Kerryn.

KERRYN PHELPS: Good morning Tracey.

COMPERE: Professor - let's repeat this - Professor Nicholas Fisk says natural childbirth is more dangerous than drink driving. Now, that can't be right, surely.

KERRYN PHELPS: Well, I think he's reflecting the beliefs of a lot of people who are involved in obstetrics where, I mean, having a baby is a reasonably high-risk business. I mean, the vast majority of deliveries go extremely well. Some don't go well. And I think that what he's saying is that for those - for, I guess, the fear that something will not go well, a lot of women are choosing to have caesarean sections now.

COMPERE: So you're basically saying that what's changed here is that in decades gone by, and several decades gone by, we accepted that element of risk, we accepted that every now and again a natural childbirth could go wrong, and now we simply don't accept anything.

KERRYN PHELPS: There's much less of an acceptance of things going wrong. You're quite right. And, of course, the other things that have changed over time is that we've got vastly more sophisticated anaesthetic techniques. Now, a woman having a caesarean would not generally have a general anaesthetic, she would have a spinal or an epidural anaesthetic. So that's safer for the mother and for the baby.

You can see here the mother having a caesarean section in the film there is awake and talking to the anaesthetist, and there's the baby coming out of the mother's abdomen and being delivered, squirming and screaming (which is exactly how you want to see them); the cord being cut and tied, and we're away.

COMPERE: Yeah.

Let me read to you as we watch this. Let me read to you part of what I thought was a really poignant letter to I think The Sydney Morning Herald from Hannah Darlen from the New South Wales Midwives Association.

'Take one healthy, pregnant woman and induce her labour unnecessarily. Add an epidural block because of the increased pain she will suffer. Now add a drip of synthetic hormones to speed up a labour that's been slowed down by the epidural. Add a forceps delivery of her baby because she can no longer push due to the epidural, and an episiotomy to allow the forceps to be used. Further extend that episiotomy to a severe tear that leads to pelvic floor problems for the rest of her life, and let her baby spend some time recovering in the neo-natal unit from the trauma it's experienced.

'No wonder birth is getting riskier than drink-driving. There's nothing natural about it.'

Do we intervene too much? Do we interfere too much with nature?

KERRYN PHELPS: That sounds like Murphy's Law of obstetrics where, you know, if one thing goes wrong, then everything will go wrong, and it's sort of putting together all of the possible complications.

I think the point is that we don't accept labours going on for 24 or 36 hours because of danger to the mother and danger to the baby. We don't accept mothers dying in childbirth now. We don't accept babies dying or being severely damaged in the child-birth process if we can intervene with a safe process called a caesarean section at a reasonable time along the track. And if labour is going off the tracks, then I think we tend to intervene earlier to do something about that.

But I think what we are seeing now is that women are starting to actually exert their right to choose whether they have natural childbirth or caesarean. And a lot of women, we have to say, are now choosing to have a caesarean rather than a natural childbirth.

COMPERE: Well, you're echoing what David Molloy, who's the president of the Association of Gynaecology and Obstetrics says, which is that women, professional women in particular, are saying that, 'Look, long labours and labours anyway are interfering with our schedule. We want to know when the baby is coming into the world.' I mean, is it as clinical as that?

KERRYN PHELPS: No it's not just about that. It's not just about suiting it to your schedule and, sort of, booking a caesarean into the rest of your appointments for the week. It's all about a woman looking at the evidence and saying, 'Well, there could well be an increased incidence of incontinence, of sexual dysfunction, of bowel problems after a natural delivery. And, you know, I don't want to have that risk later on. I don't want to even think about that risk, and I'll choose to have a caesarean.

Now, what we're opening up here is this age-old philosophical debate between the totally natural and the totally surgical, I guess. And there are a lot of opinions in between. Some people will say give natural childbirth a go. Obviously if it's not going well, have a caesarean.

COMPERE: Because the flip side to women booking caesareans is the long-running joke that obstetricians like caesareans because they don't interfere with their golf game.

I mean, are caesareans, for example, less potentially legally fraught than natural birth?

KERRYN PHELPS: I have to say I don't know too many obstetricians who have the time to go off and play golf, to be honest.

But the question has been raised as to whether because of medical litigation against obstetricians, that they are opting for what they consider to be the safer, more controlled option of caesarean section.

The obstetricians I talk to (and I don't think there's actually been a survey done about this) have said no, that that's really not an issue, that they're weighing up the evidence.

And we certainly need more evidence. We do know, for example, that caesarean, electively, is safer if you have breech. There's certainly a good case for multiple birth (with twins or triplets) for having a caesarean. It's safer for the baby. We really don't have the figures on the absolute safety for a whole population between a normal presentation of a single baby and caesarean versus vaginal delivery. So, we do need more research. But certainly I think this debate is well and truly out there. And I think Professor Fisk has opened up a can of worms.

COMPERE: I think you're right.

Thanks for being with us.

KERRYN PHELPS: Thanks Tracey.