On average, about half of mothers at Auckland Hospital give birth vaginally, and around a quarter by planned caesarean. Photo / 123rf
On average, about half of mothers at Auckland Hospital give birth vaginally, and around a quarter by planned caesarean. Photo / 123rf
A quota on elective caesarean sections is being discussed at Auckland City Hospital - a limit that would apply to private obstetricians.
The Herald understands the possibility of a planned (also called elective) caesarean section quota for private obstetricians has been raised, as part of wider discussions about the accesssuch specialists have to hospital birthing facilities.
That draft proposal is not popular with some private obstetricians, who feel the focus on c-section numbers is unnecessary and outdated.
Neither they nor hospital bosses would comment on details of the ongoing consultation, including whether any quota would be set at, above or below current caesarean numbers, and who exactly it would apply to.
It is too early to do so, said a Te Whatu Ora spokesperson for Women’s Health at Te Toka Tumai, Auckland (formerly Auckland DHB).
“We actively engage with the private obstetricians who work with us at Te Toka Tumai, and meet with them regularly through a representative group,” the spokesperson said.
“Collectively, we are discussing a potential new approach to issuing access agreements, which the group is currently consulting its partners on.
“We’re still in early discussions, however we’re looking forward to working with private obstetricians toward a consensus.”
On average, about half of mothers at Auckland Hospital give birth vaginally, and around a quarter by planned caesarean. This is high by national standards. (Updated figures are due to be released next month.)
Private obstetricians perform about 58 per cent of planned caesareans.
A caesarean may be planned (elective) or unplanned (emergency), if complications develop and delivery needs to be quick.
C-section rates at Auckland Hospital are above national averages. Photo / Jason Oxenham
New Zealand lacks private birthing facilities, and for decades women looked after by private obstetricians (at a cost of over $6000) have used Auckland Hospital’s labour and birthing facilities under access agreements with individual specialists.
Currently, 27 specialists have access, many of whom also work in a public role at the hospital.
In 2020 the hospital stopped allowing more private obstetricians to access birthing facilities, citing their high planned caesarean rates.
Hospital leaders were also unhappy that many women paying for such specialist care lived outside its central Auckland catchment, but gave birth at the hospital because it was where their obstetrician was based.
The “pause” on letting more private obstetricians work at the hospital ended last year, but strict new conditions for access agreements were introduced (applying only to new agreements, not those already issued).
The obstetrician must now treat only women living within the hospital catchment; work most of their time in a public role at the hospital; help teach others; and be on-call after hours.
Hospital management said the new regime “strikes an appropriate balance between public and private care”.
However, the Auckland Association of Private Obstetricians criticised the conditions as “impractical and inappropriate”. No new agreements have been granted in recent months.
Women cared for by private obstetricians tended to be older, the association says, with more complicated pregnancies (for example, IVF or a history of previous caesarean birth – the greatest factor determining the likelihood of another caesarean).
In 2020 board discussions, Auckland DHB chief executive Ailsa Claire raised concerns that caesareans done by private obstetricians weren’t always clinically appropriate (a claim strongly denied by the specialists) and used a lot of public resources.
Most women giving birth at the hospital could not afford a private obstetrician, Claire is recorded as saying in November 2020 minutes, and “that means when the private obstetrician comes in and uses theatre capacity, that theatre becomes unavailable to the rest of the Auckland population”.
Auckland Hospital has focused on improving equity in maternity services after concerns were raised that some mothers and babies – particularly Māori and Pasifika – were not getting the care they needed amid increasing capacity pressure. Reducing the high elective caesarean rate was part of this wider work.
Dr Jenny McDougall is now the acting director for Women’s Health, after the retirement of Julie Patterson.
