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Caesarean section in the absence of need: a pathologising paradox for public health? This qualitative study explored the discourses constructing women's choice for a caesarean section, in the absence of clinical indication. The research was informed from the theoretical ideas of poststructuralism that presumes people's reality is shaped discursively through the discourses they encounter. A Foucauldian discourse analysis was undertaken of the transcripts of participant's interviews and the texts of both professional and popular media before inductively discerning the prevailing discourses that influence the choice of caesarean in the absence of need. In shaping women's choice in childbirth the discourses of autonomy, convenience and desire alongside fear and risk were identified in the talk and texts of women, childbirth professionals and popular culture. For the purposes of this article we have confined our focus to the findings related to how caesarean is represented in both professional and popular discourse and include feminist discussions around childbirth as an embodied practice. We contend that the discourses of autonomy, desire and risk unite with broader societal discourses to expose a pathologising paradox in which normal bodily performance emerges as abnormal and the abnormal as normal. The trend has implications for both future healthy populations and the equitable distribution of maternity resources.

Background: Midwives require an expanded level of knowledge and skill to meet the complex care needs of childbearing clients and babies, along with their whānau (extended family and community) throughout their childbearing experience. Complexity in childbirth summons midwives to apply research in practice to support clinical decisions they make. Postgraduate education is key to preparing midwives with a level of expertise in the provision of evidence-based practice, with the view to improving outcomes for women and babies when care becomes complex. Aim: To explore the perceived benefits of midwifery postgraduate education for midwives, women, pregnant people, babies and maternity services, following midwives’ completion of a Postgraduate Certificate in Midwifery (Complex Care) offered at an Aotearoa New Zealand university. Method: A purposive sample of 90 midwives who completed the qualification between 2009 and 2017 were sent a link to an online, mixed method, self-report questionnaire. Twenty-seven surveys were returned and entered in Qualtrics for analysis. The qualitative component of the questionnaire is addressed in Question 13 and reported in this article. Findings: A thematic analysis found benefits of postgraduate complex care education included improved quality of care, enhanced knowledge, increased awareness of research, heightened critical thinking capabilities juxtaposed with improved professional development and enhanced communication. Conclusion: The study corroborated the premise that postgraduate midwifery complex care education is key to improving outcomes for childbearing women and babies in settings requiring complex care. Recognition of the benefits of the Postgraduate Certificate in Midwifery (Complex Care) for the provision of evidence-based practice is central to improving health outcomes when pregnancy and childbirth become complex.

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