“Regardless of how you give birth,it is an experience that should be cherished”: ensuring positive experiences during planned caesarean births for wāhine Māori in Aotearoa (New Zealand)

Abstract

Wāhine Māori (Māori women) experience a range of inequities in birth outcomes, and little has been published about the ideal service provision for caesarean births for this community. The aim of this rangahau (research) was to explore the lived experiences of wāhine Māori who have given birth by planned caesarean birth in Aotearoa (New Zealand). Ten wāhine aged 31–45 years were interviewed about their experiences of hapūtanga (pregnancy) and whakawhānau (childbirth). Inductive thematic analysis led to five themes: (a) mana motuhake (describing desires for self-determination), (b) whanaungatanga (describing positive relationships with health care providers), (c) poapoataunu ā-pāpori (describing the social stigma of planned caesarean birth), (d) kaitautoko (describing the role of birth partners), and (e) kuranga (describing experiences with education surrounding whakawhānau). The findings from this rangahau demonstrate the needs of wāhine Māori who give birth by planned caesarean with implications for the public maternity system in Aotearoa and similar contexts.

Positive birthing experiences play a crucial role in the wellbeing of māmā (mothers), impacting both their mental and physical health. While medical complications during childbirth are often seen as the primary concern, research suggests that subjective experience of birth can have a profound effect on whether the birth is perceived as traumatic (Ayers et al., 2006; Garthus-Niegel et al., 2013). Ensuring that women feel supported, informed, and empowered throughout the birthing process is therefore essential for promoting positive outcomes and reducing the likelihood of lasting psychological distress. The World Health Organization (2018) defines a positive childbirth experience as one that

. . . fulfils or exceeds a woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff. (p. 1)

Within Te Ao Māori (Māori worldview), the time around whakawhānau (childbirth) is sacred, a transition from the womb into Te Ao Mārama (the world of light). Such a time should be met with feelings of safety, empowerment, and support from those caring for the wahine (woman) and her pēpi (infant), but little is known about the ideal service provision for different birthing modalities for wāhine Māori (Māori women).

New Zealand health care provider, Te Whatu Ora (2022), defines an elective/planned caesarean birth (CB) as “a caesarean section performed as a planned procedure before or following the onset of labour, where the decision to have a caesarean section was made before labour” (p. 19). However, the term “elective” may be interpreted by the general population as the mother choosing or demanding a CB (Tully & Ball, 2013). Thus, we use the term planned CB, to better reflect the distinction between an emergency operation (i.e., unplanned) and a planned operation (including those medically indicated). In Aotearoa (New Zealand), the number of CBs has trended upwards over the last decade, accounting for 31.5% of all births across all ethnicities and 24.1% of births for Māori. 12.5% of all CBs in Aotearoa are planned CBs (Te Whatu Ora, 2022).

CBs are one of the most common obstetric surgeries and are often a life-saving procedure for māmā and pēpi (Darnal & Dangal, 2020). However, both emergency and planned CBs can be associated with short- and long-term risks of māmā and pēpi, including effects on physical health (such as increased risk of future uterine rupture, abnormal placentation, ectopic pregnancy, and stillbirth; Sandall et al., 2018) and mental health (such as postnatal depression (Ogbo et al., 2018), post-traumatic stress (Bodin et al., 2022), and birth dissatisfaction (Hoffmann et al., 2024; Sandall et al., 2018). Planning a CB can happen for several reasons, including prior CB, prior negative birth experience, or medical complications such as placenta previa (Hoffmann et al., 2024). While researchers have argued that the preparation time that comes with a planned CB, alongside proper care during the post-operative period, can decrease maternal and foetal complications (Darnal & Dangal, 2020) compared to emergency CB, planned CB comes with its own challenges. Social stigma is a major concern for many women considering planned CB. The notion “too posh to push” and societal beliefs around vaginal births being a rite of passage into motherhood can be damaging to wāhine who feel the need to justify their experiences and challenge the stigma (Cripe, 2018; Hoffmann et al., 2024). Birth satisfaction has been shown to be impacted by the way individuals perceive their birth experiences (Garthus-Niegel et al., 2013), including feelings of control and autonomy during whakawhānau.

Marginalised groups, including Indigenous peoples, are more likely to experience negative outcomes such as postnatal depression following CB, compared to vaginal birth (Ogbo et al., 2018). Past research has found that wāhine Māori require perinatal care that is holistic in nature, focusing on all areas of wellbeing for wāhine and pēpi (Below, 2024; Lawrie et al., 2024). Sir Mason Durie’s (2011) Māori model of health, Te Whare Tapa Whā, espouses four dimensions of hauora (health) and emphasises the holistic nature of wellbeing: te taha tinana (physical), te taha whānau (social), te taha wairua (spiritual), and te taha hinengaro (mental/emotional). Māori traditions, such as sharing birth stories, can address several dimensions of hauora by helping wāhine to make sense of their birthing experiences, but can also leave wāhine who are considering or have had a planned CB feeling stigmatised.

Indigenous communities have increasingly sought to improve the outcomes of Indigenous women and infants by implementing community-based programmes that incorporate Indigenous rites and beliefs into clinical practice. Family-Centred Maternity and Newborn Care (FCMNC) is a clinical care movement in Canada which seeks to ensure Indigenous peoples have culturally-safe and culturally-affirming care during pregnancy and birth (Hayward & Cidro, 2021). FCMNC recommends that hospital and birth centres treat birthing as a ceremony, with distinct customs and rituals attached. Further, FCMNC acknowledges the barriers to perinatal care among Indigenous women, including difficulty with transport, mistrust of the medical system, and lack of social support. In Australia, the Birthing in Our Community (BiOC) service aims to meet the needs of First Nations women and their families during the perinatal period by providing services which help address current health disparities (Haora et al., 2023). In Aotearoa, Hapū Wānanga ki Taranaki is an antenatal education programme established to provide a safe and supportive environment where all wāhine and their whānau feel empowered to embrace and reclaim traditional birthing practices. Their vision is for every Māori pēpi to be born into loving whānau, deeply connected to Te Ao Māori, with a strong sense of identity and whakapapa (Hapū Wānanga ki Taranaki, 2025). Community programmes like these align with the United Nations Declaration on the rights of Indigenous Peoples (UNDRIP; United Nations, 2007). UNDRIP recognises that Indigenous Peoples often have a dual existence, seeking to remain connected to their cultural traditions, beliefs, and values, while also seeking health care within a system which prioritises Western beliefs and values. These community-based programmes can help merge the two realities.

Prior to colonisation of Aotearoa by the British Crown, traditional practices around hapūtanga (pregnancy) and whakawhānau were an integral part of Māori society (Wepa & Te Huia, 2006). Female rangatahi (adolescents) were traditionally taught tikanga (customary practices or principles) surrounding the sacred time, as well as being educated in sexuality and the importance of wāhine, who are referred to as te whare tangata (literally meaning the storehouse of humankind) because of the life and nurture they provide (Wepa & Te Huia, 2006). In traditional Māori society, wāhine are recognised for role they play in giving life, respected, and treated with the same consideration as Papatūānuku, the supreme female deity and creator of all life (Higgins & Meredith, 2017). There are several customs that whānau (family) engaged in during hapūtanga, whakawhānau, and the postpartum period, including karakia (incantations), pūrākau (storytelling), oriori (songs about whakapapa [genealogy]), mirimiri (bodywork), taonga pūoro (Māori musical instruments), and returning the whenua (placenta) to the earth through a burial process (Simmonds, 2017; Wepa & Te Huia, 2006). Hapūtanga and whakawhānau were a celebration where māmā and pēpi were supported and cared for by whānau, with the pēpi considered tapu (sacred) and close to atua (deity) (Walker, 2022).

The devastating effects of colonisation have been far-reaching for iwi (Māori tribes) (Brown & Bryder, 2023), and has had substantial impacts on maternity care. With European contact came the dismissal and undermining of many Māori practices and customs, the introduction of new diseases, criminalisation of traditional healing practices (Tohunga Suppression Act 1907), and ultimately the loss of information surrounding important cultural practices (Tikao, 2020). Wāhine Māori have been denied health care services that support cultural beliefs; for example, until the health reforms of the 1990s, wāhine were banned from traditional labour and birthing techniques in hospitals such as squatting or kneeling (Wepa & Te Huia, 2006). This may mean that wāhine feel uncomfortable speaking up in health care settings, may accept medical advice without question, or feel disempowered to make requests which support their own cultural safety in maternity spaces. In Aotearoa, Māori mothers are three times more likely to die by suicide than non-Māori mothers (Perinatal and Maternal Mortality Review Committee, 2022). This devastating statistic highlights the urgent need to understand the experiences of wāhine Māori during the perinatal period.

The Crown has obligations to Māori under Te Tiriti o Waitangi (The Treaty of Waitangi) to ensure equitable health and disability outcomes for Māori (Brown & Bryder, 2023). Within the maternity space and health care system, wāhine have the right to practice self-determination and to live and act in accordance with Māori beliefs (Barnes et al., 2013). Although CBs almost exclusively occur within a Western medical setting, specifically hospitals, they can be performed in culturally-safe and culturally-affirming ways, including incorporating traditional birthing practices. For example, Lawrie et al. (2024) found that the incorporation of traditional practices contributed to a positive birthing experience for wāhine Māori having emergency CBs. Although some cultural beliefs have become accepted protocols in Aotearoa hospitals, such as retaining the whenua and returning it to the whānau after birth, other practices could also be considered. In this study, we explored which cultural practices wāhine felt should be incorporated during whakawhānau via planned CB, and how hospitals and health care providers had accommodated their needs during planned CB. Wāhine Māori, their pēpi, and their whānau deserve health care which takes a holistic approach and acknowledges their need for preservation of cultural traditions which result in feelings of safety and empowerment.

Addressing health inequities such as inequities in birth outcomes relies on understanding the lived experiences of Māori; thus, this qualitative study afforded participants the opportunity to share their experiences of care within the health care system. We explored the experiences of wāhine Māori who have had planned CBs, exploring their perceptions of choice and control during the decision-making process and birth, their ability to include cultural birthing practices, their experiences of care from health care professionals, and their views of the societal understanding of CBs. Wāhine were asked to describe what they considered to be positive and/or negative aspects of their planned CB birth experiences. The overall aims of this study were to understand the experiences of wāhine Māori during planned CB in Aotearoa, to understand how the health care system currently supports wāhine and their whānau, and to hear their suggestions for how health care systems can better meet the needs of Māori.

Methods

Study design

This rangahau is guided by principles of Kaupapa Māori research (a framework rooted in Māori values) that are grounded in mātauranga Māori (Māori knowledge), Te Reo Māori (Māori language), and tikanga Māori, all of which are essential pathways to understanding Māori ways of being (Cram, 2019). More broadly, this research is conceptualised within Mana Wahine theory (Pihama, 2020), acknowledging the issues faced by wāhine Māori and actively seeking to reassert our place on our tūrangawaewae (ancestral lands). It is essential to remember that wāhine Māori are not a homogeneous group and that these birthing experiences are the stories of individuals who come with individual expressions of self, based on life experiences and whakapapa relations.

Approvals

Ethical approval was obtained from the University of Otago Human Ethics Committee (H22/078). The Ngāi Tahu Research Consultation Committee was also consulted. Verbal and written consent was obtained from each participant.

Study setting and participants

Participants were 10 wāhine Māori, ranging in age from 31 to 45 years, who had given birth by planned CB in Aotearoa. Participants had given birth ranging from 6 weeks to 16 years prior to their interview. Participants were recruited via posters displayed on social media and shared through researcher networks. Semi-structured interviews took place kanohi-ki-te-kanohi (face-to-face) for four wāhine and via Zoom for six wāhine. Participants were invited to bring whānau to the interview if they chose. One participant brought her child to the interview in person, and two had their pēpi with them as needed during Zoom interviews. Kai (food) was shared at the interviews held in person and karakia were offered at the beginning and end of each interview in keeping with tikanga Māori. All participants received a koha (gift) of a grocery voucher. Participants described varying degrees of connection to their whakapapa and understanding of Te Ao Māori, ranging from being raised with an understanding of Te Reo Māori and tikanga, to reconnecting during their adult life. While the focus of this research is cisgender women giving birth and we use the terms women and mother throughout, we acknowledge that birth can be experienced by transgender men and non-binary people.

Data collection and analysis

Interviews ranged from 27 to 64 minutes (M = 51 minutes) and involved a semi-structured approach using open-ended questions. Interviews were undertaken, recorded, and transcribed using Otter.ai (Liang & Fu, 2016). Maximum privacy options were used and the overall handling of data is in keeping with data sovereignty principles (Te Mana Raraunga, 2025) as it is held by Māori researchers with input and participant access to their own data. Any errors found in the initial transcription were manually corrected. All transcripts were anonymised to maintain confidentiality of the participants; non-meaningful verbosity was not included in the quotes in the results section of this article. Any omissions did not change the meaning of the quote.

Braun and Clarke’s (2022) approach to thematic analysis was used to identify themes across the interviews. All interviews were re-read at least twice for data familiarisation. Codes were then assigned to extracts using NVivo (Version 1.6.1); these codes were then grouped into broader categories which became preliminary themes. Finally, transcripts were read again with the themes in mind to make further refinements to the themes and include the most relevant supporting quotes. The themes were discussed among the co-authors, resulting in further refinements.

Results

Five themes were developed from the analysis. Each theme is described in the following sections along with supporting quotes from the participants. Table 1 summarises the five themes.

Table 1.

Themes relating to the experiences of wāhine Māori giving birth by planned caesarean birth in Aotearoa.

Theme	Description
1. Mana Motuhake	Experiences of self-determination during hapūtanga and whakawhānau.
2. Whanaungatanga	The development of positive relationships between wāhine and healthcare providers.
3. Poapoataunu ā-pāpori	Perceptions of how caesarean are viewed and understood in society.
4. Kaitautoko	The role and involvement of birth partners during labour, birth, and throughout recovery.
5. Kuranga	The impact of formal and non-formal education about labour and birth.

Theme 1: Mana Motuhake: experiences of self-determination during hapūtanga and whakawhānau

The first theme that was evident was participants’ experiences with health professionals across their hapūtanga and whakawhānau, specifically whether they felt they had the ability to express their desire, to practice self-determination, were respected in their choices, and felt seen as individuals. Several of the wāhine discussed how health care providers presented them with the risks and benefits of different birthing options, but ultimately left the final decision up to them. This resulted in feelings of empowerment for the individual, allowed them to feel in control of the process, and contributed to a positive experience:

I found that empathy, and that kindness in their approach, they really humanised my experience of it. Because on a medical piece of paper, it was as simple as, you have complete placenta previa, you just have to have a c-section, it is what it is. If I had birthed, 200 years ago, we would have both died. It’s as simple as that . . . I really felt seen and heard, and I was an individual in their spaces. (Zoe, 37 years old)

Going into it, I didn’t want to be forced either way, I guess. I like to make my own decisions with my body I suppose. But I did feel, but I had a really, really lovely midwife and she advocated for me really well as well. (Laura, 34 years old)

While some participants felt in control during the decision-making process, this was not the case for everyone. Participants also mentioned feeling left out of the decision-making process due to the input of others, which made them feel powerless and like they had to go along with the decision that was being made for them:

I definitely felt like I didn’t have a lot of say in it, even though it was about me, which was kind of weird . . . So yeah, partly felt like [they] were making the decision with the obstetrician and not me making the decision. I kind of felt like I was just going along for it. Yeah, I didn’t really feel like I had a lot of power in that situation. (Charlotte, 39 years old)

Other participants reflected on whether or not wāhine truly have choice in what care they receive given the accessibility of certain services, such as CBs and the costs associated with such procedures:

I think a lot of choices do get made out of what’s available, resource-wise, not necessarily what people want. And so whenever I hear about women’s choice, women can choose, I’m always a bit like, yeah, but can they though? I’m not sure about that. All things being equal, maybe we could say that it’s a woman’s choice, but I don’t think it’s a woman’s choice, if finances or resources available locally to where they are, come into play. (Tara, 44 years old)

Several participants talked about midwives and obstetricians who gave them the space during their pre-operative care and the CB, to engage in cultural practices. While acknowledging that a CB is a surgery and certain protocols are medically necessary, health care providers who also considered tikanga throughout that process were highly valued by the participants. When describing how important it was for her tāne (male partner) to cut the umbilical cord, one participant shared:

And there was a few tikanga things that I really wanted them to uphold. And one in particular was, I really, really wanted the first bare hands on pēpi to be my tāne’s hands, or mine. I really believe strongly, and those in my whanau, have kind of shared with me that you know, we kind of believe that whakapapa is transferred from skin to skin contact as well as through our DNA, of course. So that was really important to me. . .so that part in terms of tikanga went really well. I felt like the surgeon, though she didn’t particularly want to do it, she upheld my wishes and my values there. (Zoe, 37 years old)

Theme 2: Whanaungatanga: positive relationships between wāhine and health care providers

The second theme is about the relationship between wāhine and health care providers, most notably midwives and obstetricians. These relationships were often referred to by participants as playing a significant role in their overall experience. Moreover, these relationships benefitted greatly when providers were open to learning and showed respect for the values and beliefs of wāhine. Participants shared how much they appreciated the midwives who took the time to understand tikanga and implement that into their practice with wāhine Māori. They shared that they were grateful when their Pākehā (New Zealander of European descent) midwives were open to learning about cultural values and beliefs and provided care which was specific for Māori māmā:

Even though she was Pākehā, she was very, like, mindful of, of my connection to Te Ao Māori, and she was totally open to any and all, conversations, and what’s the word, just certain things of how I wanted it to be done, what I was used to, especially when things came to my body. I firmly believe that my body is quite tapu and she would always ask for consent, and she was always just so very lovely and kind. (Tessa, 37 years old)

And I just thought that was really lovely that she was, she cared, that she was engaging, that she was checking, and she really wanted to learn more, but also to make sure that her, like her māmā Māori had options of places to go to feel like they were being, like that I was being supported in the way I wanted to be supported. (Zoe, 37 years old)

Several participants mentioned positive care they received, for example, making formal introductions of all those involved in the procedure and checking to see how wāhine wanted to be treated. However, participants who had given birth multiple times by CB shared that these practices did not occur every time:

I knew everyone in the room, I knew what their role was. I knew that she was taking care of me and taking her time, being respectful. It’s just all of that stuff, which is like, really should be common sense, but that would be really nice for that to happen every time, you know, every time. (Anahera, 39 years old)

I think it’s the first medical professional I’ve had, that first midwife, who treated me as Māori, especially as someone who’s quite Pākehā-looking [i.e., White-looking], and made sure that I felt, like she kind of asked me right from the beginning, how do you want to be treated? (Zoe, 37 years old)

Participants also commented about the type of care that they did not receive and emphasised aspects that would have contributed to their experience being more positive and culturally-affirming:

I think it would be nice to have someone who just sort of is talking to you, probably someone who has the same cultural values as you. I feel sometimes, like when you go into certain spaces, you have to quickly adjust to the culture in the room, especially when they’ve got all the power, you know, they’re the ones that are going to be cutting you open, they’re the ones going to be taking your baby out. So it’s like you go into a space and you think, okay, who do I need to be in the space just so that everything goes smoothly. (Maria, 45 years)

Theme 3: Poapoataunu ā-pāpori: perceptions of social stigma surrounding caesarean births

The third theme is around social stigma; each wāhine shared some of the negative ways that society views CBs. This ranged from feeling as though CBs are viewed as an “easy way out” (Anahera), a “cop out” (Maria), or that those who have a CB are not “real women” (Laura). Every participant shared that CBs are overwhelmingly viewed in a negative light by society. Some participants mentioned that this narrative may be shifting, however, negative views and beliefs are still prevalent. Each participant shared how they believe society responds to CB as a mode of birth. In many cases, interactions with people left participants feeling as though their decision to have a CB was negative:

But I definitely felt that it was almost like frowned upon to choose to birth my baby like that. (Tessa, 37 years old)

It kind of feels like if you don’t have a baby, the natural way, it’s like you’re a bit of a wuss, or you chose that because you don’t want to do the pushing or whatever. (Maria, 45 years old)

Some participants shared that they opted for a CB over a vaginal birth, a decision which they appreciated being able to make. However, other participants felt that the terms “elective” or “planned” suggested to others that they actively chose a CB over other birth options. For several of our participants, this was not the case; rather, a CB presented the lowest medical risk for our participants and their pēpi. In this sense, there was no “choice”; in fact, one participant preferred to describe her caesarean as “necessary” rather than “elective”:

Because it’s not, for a lot of women, it’s not, even though it’s elective, it’s not actually how you would choose, it’s been chosen for you by the fact that you have a health condition or an injury or whatever. (Maria, 45 years old)

Some participants felt a need to justify their decision to others. One participant chose to avoid talking about their caesarean in social settings so they did not have to explain:

Yeah, I think that, especially in my experience of it, there was a lot of assumption that it was something I wanted, rather than something that I had to have. (Zoe, 37 years old)

Theme 4: Kaitautoko: the role and involvement of birth partners during birth and recovery

The fourth theme is about the pivotal role of birth partners for wāhine during planned CB. Discussions included the way partners supported their decision-making and what they did to provide support. Participants also shared how their birth partners responded to the surgery and supported that they needed themselves. All participants shared how important it was to have the support of their partner during hapūtanga and whakawhānau. Some participants shared how vital it was for their relationship to be stable so that they were given the type of support and help they needed.

And then my second very significant important thing would have been my partner, yeah, like I said, he’s just such a good helpmate and companion to me. And being able to make sure our relationship was strong before, during, and after this whole process was very important to me. I would not be able to do this without him. (Tessa, 37 years old)

When asked what the role of her birth partner was and how he showed his support, one participant responded that he was:

Really supportive during the whole process, really, really supportive of what I was keen to do, talked about, it was a shared decision. During the delivery itself, he was there, just holding my hand, talking me through. And he was the one that . . . cut the cord, tied the muka (flax fibre), sorted baby out. (Anahera, 39 years old)

However, several participants expressed that their birth partners felt unprepared for the caesarean procedure, not knowing what to fully expect, and having to process it all after the birth. For some partners, supporting the māmā through CB was challenging, including feeling powerless or out of control:

He said he got home, and he had a shower, and he just like stood there, like what the fuck just happened today? Like, just being so tired? I don’t think he has fully probably processed some of that or like talked through it. (Leah, 36 years old)

Because nobody really thinks about what the experience is like for them and no one prepares them for it. You know, you’re just sort of, you go into the room now and watch your wife be cut open, and you know, it must be quite shocking for them and at the same time, they’ve got that, that an inherent sort of, oh, I’m the man I have to I have to be brave, and I have to support my wife and I have to be okay with everything and, and they don’t really know what’s happening any more than you. (Maria, 45 years old)

Theme 5: Kuranga: the impact of formal and non-formal education about labour and birth

The fifth theme discussed by each participant was their experiences within antenatal education. This included formal education through community organisations, Kaupapa Māori-centred antenatal classes, and the sharing of stories between whānau members and friends. These opportunities to learn about birth and CBs provided participants with knowledge going into their birthing experience. Most of the participants mentioned that community-run antenatal classes, whether they take a mainstream approach or a Kaupapa Māori approach, had a primary focus on vaginal births and did not provide in-depth information about CB:

It was pretty skewed towards a normal vaginal delivery, because, of course, that’s what most people do have . . . So it was, there was a lot going on in the course, that was maybe not as targeted towards me. (Tara, 44 years old)

Yeah, for like 10 minutes, because I was the only mama who was planning to have one. And they kind of talked about what would happen if you had to have an emergency, but not really in depth. (Zoe, 37 years old)

While several participants had attended mainstream antenatal classes, they noted that antenatal classes taking a Kaupapa Māori approach, such as hapūtanga wānanga, would be beneficial for them to connect to Te Ao Māori and increase their understanding of traditional birthing practices and customs through pūrākau. They shared what they would like to get out of attending such courses:

And I think for me, and what, probably lots of other wāhine Māori that are still sort of figuring out how to incorporate culture into their daily lives in safe ways. So, I guess it would be, just sort of knowing more about that side of things, like more about the tikanga side of things . . . I wish that I had thought more about just the cultural side of having a baby and I wish I had had a bit of guidance. (Maria, 45 years old)

Discussion

This rangahau explored the unique experiences of wāhine Māori in Aotearoa who have given birth by planned CB. The five themes highlight several critical aspects of the experiences of these wāhine. There are several aspects of whakawhānau that come together to create an environment which is culturally safe, empowering, and conducive of a positive experience. Overall, the findings demonstrate the significance of centering wāhine Māori voices in maternity care, with implications for culturally responsive and equitable health care practices.

Consistent with prior rangahau by Lawrie et al. (2024) with wāhine Māori who experienced emergency CB, the wāhine who participated in this study shared the importance of mana motuhake (Theme 1) being central to a positive birthing experience when giving birth by planned CB. Being empowered to make decisions about their bodies, to be unapologetically Māori, to perform cultural rituals and practices with the support of midwives and obstetricians, was welcomed by participants and contributed to birth satisfaction. Setting aside time for whānau to share karakia during pre-operative care, allowing birth partners to separate the pēpi from the whenua, and allowing more than one whānau member in the operating room, are some ways which health care providers can ensure culturally-affirming care during a CB. Health care providers who seek to learn about such practices and use them in their practice are crucial to a positive birth (Theme 2). In addition, applying Māori models of health such as Te Whare Tapa Whā (Durie, 2011) and the Meihana Model (Pitama et al., 2007; Pitama et al., 2017) into practice is essential to culturally-safe care. These models and the Hui Process of consultation (Pitama et al., 2017) are now taught to many medical students and other health professionals. In Aotearoa, where Māori values such as tapu and whakapapa are central to identity, ensuring that cultural beliefs are upheld during birth is particularly crucial (Nisa-Waller et al., 2024). Some wāhine brought attention to barriers to full engagement during the decision-making process, most notably, broader issues in maternal health care where autonomy is overshadowed by systemic limitations such as the availability of resources.

Participants also shared experiences which were unique to planned CBs, specifically poapoataunu ā-pāpori (Theme 3). All participants shared that they believe society has a negative view towards CB, but there was an added layer of stigma associated with planned CB as it is often assumed wāhine have requested a CB over a vaginal birth in the absence of any clinical indications. However, as several participants shared, for them a CB was a safer and lower-risk option than vaginal birth for their pēpi and/or themselves. In this sense, there was no option other than a planned CB, and to assume that the decision was made out of comfort or ease or to avoid the pain associated with vaginal birth, was hurtful to participants. For some participants, having a CB meant letting go of the birth they had always envisioned and came with associated grief and disappointment. Social education could therefore aid in reducing stigma by sharing the complexities of childbirth and various modes of birth which support maternal and infant health.

Along with social education, antenatal education needs to include in-depth discussion around CBs and what they entail, including reasons for opting for this modality, what to expect, what recovery may look like, and how wāhine and their whānau can prepare (Theme 4). Even if vaginal births are the preferred mode of birth for many, one in three wāhine in Aotearoa will have a CB (Te Whatu Ora, 2022). Thus, increased education is essential. This includes education received in mainstream and Kaupapa Māori courses, including hapūtanga wānanga. Participants spoke about the value of hapūtanga wananga and how beneficial they are to increasing one’s knowledge of Te Ao Māori and tikanga around hapūtanga and whakawhānau. The lived experiences of the participants emphasised the value of Kaupapa Māori approaches to health care and education, specifically in the maternity space where colonisation has caused disconnection from traditional customs and practices. This is consistent with prior research that emphasises the importance of Te Ao Māori being embedded within antenatal education, rather than an add-on (Barrett et al., 2022). The existence of such courses are uplifting Māori and provides them with opportunities for reconnection and revitalisation.

Finally, consistent with the experience of emergency CBs, the presence of supportive partners during planned CB was essential for wāhine (Theme 5), who emphasised the importance of the emotional and practical support they received from their partners (Lawrie et al., 2024). The inability for partners to stay overnight with wāhine due to hospital policy was difficult, especially when a CB limits one’s ability to move around with ease or tend to their baby. Birth partners also experienced challenges themselves, with wāhine commenting on partners’ feelings of being unprepared for the realities of CB and experiences of feeling out of control or powerless in the situation.

This rangahau has both strengths and limitations. The use of Zoom interviews can be less interactive and occasionally subject to technical issues; however, rapport was still established, and Zoom allowed us to overcome geographical limitations and interview a diversity of participants from across the country. An additional consideration is the variation in time since participants gave birth. Although childbirth is often described as a significant life event, the level of detail recalled may differ depending on how recently the birth occurred. However, the consistency of themes across participants suggests that this variation did not substantially impact the findings. Another limitation is that birth partners were not present at the interviews. As discussed by participants, birth partners play a crucial role in wāhine Māori birthing experiences, providing emotional, physical, and cultural support. Without these perspectives, the study may not fully capture the collective aspects of the birth, which are central to Māori cultural values and whānau-centred care. Future rangahau could focus on birth partners to hear their perspectives and highlight what would be helpful for them to support the birthing māmā and their families, as well as themselves, during a CB. Another issue that shapes the findings of this study is that the primary interviewer (the first author) has experienced an emergency CB. Finally, personal experience with emergency CB may have shaped perceptions of participants’ responses and could have led to subtle comparisons or unintentional prompting that may have affected the participants’ narratives. However, notions of reflection and reflexivity were applied through the research to bear in mind the influence of the interviewer’s personal experience and foreground the experiences of the wāhine who participated. Being an insider researcher as a wāhine Māori with experience of CB also brings the benefits of being able to build rapport with participants through a shared experience within health care.

Conclusion

In conclusion, this study highlights the multifaceted experiences of wāhine Māori during planned CB, emphasising the importance of mana motuhake, culturally-affirming care, and whānau support. The findings suggest a need for systemic changes in health care systems and societal attitudes to better support wāhine Māori in their birthing experiences. Expanding antenatal education to include comprehensive information about all birthing options including planned CB, and ensuring that cultural practices are respected within health care settings are vital steps towards improving maternal health care outcomes for wāhine Māori in Aotearoa. One participant summed it up when they shared this thought:

Regardless of how you give birth, it is an experience that should be cherished, and every wahine Māori deserves to feel respected and supported, and loved and cared for during that time. (Tessa, 35 years old)