Requests for caesareans are "frowned upon" across Queensland Health because they're less cost-effective and carry greater risk, an inquest into a baby's death has heard.
First-time mother Simone Tonkin had to undergo an emergency caesarean at Royal Brisbane Women's Hospital in June 2014 after her son Nixon became stuck in the birthing canal.
Baby Nixon died shortly after delivery and suffered skull fractures, hemorrhaging and brain swelling, most likely caused when a midwife pressed two fingers against his head to reverse the obstruction.
Medical staff were not anticipating a difficult delivery, but as time went on problems intensified, the Brisbane Coroners Court heard.
An obstetric registrar told the court on on Tuesday Mrs Tonkin, who had gestational diabetes, hypertension, depression and was carrying a large baby, did not meet any of the guidelines for a C-section.
The registrar said she believed requests for caesareans were "frowned upon" across Queensland Health because normal vaginal births were "more cost effective".
"There's always a pressure to aim for vaginal birth over a caesar," she said.
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She also said as a major surgery, caesareans carried greater side effects and a possible financial burden for patients.
"A normal vaginal birth is the best outcome but an emergency caesar is the worst outcome, so it's a grey area in between," she said.
The court heard the World Health Organisation's guidelines state caesareans should only be carried out when medically necessary.
The registrar also noted RBWH was "more happy" to do caesareans than other places because of staff ethos.
"In general that's the feel," she said.
None of the medical staff involved in Mrs Tonkin's case can be named for legal reasons.