Zann Hoad and Robyn Sheldon: In "Death of the natural birth?" last Sunday, Claire Keeton comments on the state of Caesarean births in South Africa.

She quotes Professor Lynette Denny who alerts readers to the poorer outcomes of Caesarean sections as compared to low-risk natural birth. These are corroborated by more than 300 studies that were reviewed by Childbirth Connection, a foundation promoting evidence-based obstetric practice in the US.

The studies, comparing natural birth to uncomplicated Caesarean delivery, show, among other things, that with Caesarean deliveries in first world countries:

• Women are two to five times more likely to die giving birth;
• They have 10 times the need for narcotic pain relief after birth; and
• They have two-and-a-half times poorer birth experiences.

Ms Keeton reports that we have a Caesarean section rate of 70% in our private sector, which is five times higher than the WHO recommendation of 10% - 15% for optimal benefit to mother and baby. Given the enormous deviance from recommended practice of this statistic, perhaps we need not only be questioning the safety of the Caesarean, but also be asking our obstetric providers entirely different questions about what having a Caesarean means to the mother/baby:

• What emotional and long-term psychological impact does Caesarean birth have on babies?
• Would a Caesarean section be more traumatic for a baby considering that:
• The umbilical cord is cut immediately in theatre, so the baby needs to gasp for air while its lungs are still filled with amniotic fluid; (this is an especially relevant question at a Caesarean birth since in vaginal deliveries, the lung compression in the birth canal squeezes much of the amniotic fluid out of the infant's lungs);

• Skin-to-skin contact seldom occurs between mother and baby at a Caesarean birth;
• The theatre environment is clinical, sterile, efficient and the welcome and love a baby deserves at birth is generally given secondary importance;
• What effect will the birth have on the mother's self-esteem and ability to parent? Studies show that women who experience a pregnancy and birth, where they are active participants in the birth choices being made, have more satisfying birth experiences. Mothers who have a positive birth experience have been shown to bond better with their babies and breast-feed more easily;

• How much of our desperate desire to be "seen" and recognised in our first world, highly technocratic society, stems from not being "seen" at birth. Tibetans traditionally had no concept of low self-esteem in their culture.

How much of that stems from their birth practices of keeping their babies very close to their mothers, and of their babies being recognised and "seen" at birth and in the crucial, early post-partum period?