Women 'sitting ducks for interventions' at hospitals with high-tech facilities: expert.
Statistics showing a renewed increase in the rates of caesarean birth operations have sparked a push for more facilities which focus solely on straightforward deliveries.
The Waitemata District Health Board yesterday published its 2012 caesarean rate, which rose to a new high of 29 per cent. The previous high of 27 per cent occurred in 2009, followed by a small dip for two years.
The rate at Waitemata's North Shore Hospital is, at around one-third of all births, on a par with Auckland City Hospital's, but both facilities are designed to cater, in part, for women at increased risk of complications.
Officials who analysed the Waitemata figures are at a loss to fully explain the DHB's increase from 25 per cent in 2011, but a maternity services advocate says it underlines the need to build a new low-tech primary maternity unit dedicated to non-instrumental births.
"As a low-risk first-time mother going to a secondary or tertiary level hospital you are a sitting duck for interventions," said Lynda Williams, the Maternity Services Consumer Council's co-ordinator.
Waitemata's clinical director of obstetrics Dr Sue Belgrave said there was some evidence to support this assertion that just being in a high-tech hospital increased a woman's likelihood of having a caesarean.
The district's low-risk women mainly gave birth in such hospitals and "that's the kind of issue under debate".
"If we are ever going to address [the increasing rate of caesareans] we need dramatic changes in the model of care rather than just minor tweaks at each hospital."
When asked if she accepted the need to establish a new primary maternity unit, she said: "That's part of the discussions."
Ms Williams said urban West Auckland desperately needed such a unit, to give women an alternative to Waitakere Hospital.
Others suggest a site near North Shore Hospital - to allow speedy transfers when births don't go as planned - or in the rapidly growing areas of Albany or Silverdale.
Ms Williams said women in the Helensville and Warkworth areas were well served by small trust-owned primary maternity units.
"They're fabulous. They really nurture the women and look after the women. It's what having a baby should be like.
"We held public meetings and we have been to see various MPs about the need for a primary unit in West Auckland."
She said some women from the North Shore and West Auckland went to Birthcare Auckland to give birth.
Birthcare, in Parnell, near Auckland City Hospital, generally caters only for straightforward births. Counties Manukau DHB, whose caesarean rate remains lower than the city's other districts partly because of its high Maori and Pacific populations and their younger ages of giving birth, has three primary maternity units.
No more, says mum unsettled by surgery
Mother-of-three Nicola Mapletoft has been put off having a fourth child because her last birth was a caesarean.
The 32-year-old, of Ranui in West Auckland, said problems with the placenta meant her daughter Poppy had stopped growing in the uterus so there was little choice but to have her delivered surgically.
Poppy was eight weeks premature and weighed 1.5kg when she was born last September at Auckland City Hospital.
She was admitted to the neonatal intensive care unit for the first few days of her life. She is now doing well.
Mrs Mapletoft said there was a sense of powerlessness that went with having a caesarean.
"Once they start down that path you lose control over your labour and birth. It's what's happening to you, not what you are being involved in, which is the sad thing about caesarean sections.
"Yes, they save lives and are needed but there are times they are not," said Mrs Mapletoft, a childbirth educator.
She initially found it "hard to connect" with her baby because there had been no labour and she was left in the theatre to have the caesarean wound stitched up while Poppy was taken to intensive care.
The plan had been to have four children, "but we'll now stop with three".
"I think that having a caesarean section this time around, it's put me off having another baby, because I wouldn't want to have to have another [caesarean]," said Mrs Mapletoft, whose two older children, boys aged 6 and 12, were delivered naturally.
At Auckland City Hospital, the most common reason for having a caesarean is having had one previously.