Another jump in caesarean section rates

Recently the Otago Daily times published and article which reported that the caesarean section rate in Dunedin hospital had reached the rate of 42.6% in the month of February 2011. I was moved to post this on my facebook page and this resulted in conversation some of which I wish to share here. The reason for this post is to try to stimulate a wider discussion.
What do you think about this rate of intervention in what, for most women and babies, should be a normal and natural process?
Is there anything you think that midwives can do to help turn this around?

Here are some of the comments I placed on my facebook page.

I am greatly worried but these statistics. Jenny says that when the decision is scrutinised there is a reason for that particular caesarean. However the reasons for performing caesarean seem to grow all the time. How do so many women get to this point where they are being advised to have a caesarean?

It is an enormously complex issue. There isn't one group who are more accountable for these statistics than another, one group cannot change this. For years now we (well midwives at least) have been gasping in horror at ever rising caesarean rates.I think, as more and more women birth by caesarean it (CS) becomes less feared. While more and more women are afraid to birth away from secondary care services because they might need to have a caesarean or other intervention. We shouldn't ...forget that caesarean is not the only intervention in the birth process. Every birth then virtually becomes a "trial of labour". I do think as midwives we have a responsibility to help women and those close to them to understand that the best way, for the 80% of women who can anticipate having natural, uncomplicated birth to achieve that, is to choose to birth away from secondary care services.
I think it is a society issue and until society are shocked and horrified and choose to do something about it there is little else that we can do. Many midwives too are frightened to take that step to experience birth away from secondary ca...re services. As a midwifery educator this is something I struggle with every day. How do I play my part in trying to help midwives see what is happening and find the way to support the women they work with to birth away from secondary care services, whether that is at home or in a primary unit? Without blame we need to look at every birth and try to see the decision points which led to intervention in the normal process, assess where this could have been changed and how this might impact on the outcome.