Fewer caesareans with 'midwife-centred care'

Photo / Bay of Plenty Times

The district health board responsible for the most births in Australasia is bucking the national trend - reporting low figures for caesarean section deliveries.

Unlike other DHBs in the Auckland region with statistics well above the national average of 24.3 per cent, Counties Manukau DHB reported caesarean delivery figures of 17.08 per cent of all births for 2009.

Counties Manukau provides high-risk maternity care at Middlemore Hospital and primary maternity care at community units in Pukekohe, Botany Downs and Papakura.

Last year the district oversaw the delivery of 1050 babies.

Service manager for the Counties Manukau DHB Marlene Stratton said the core philosophy of care was centred on midwives, and this had been reflected in the low caesarean delivery rates.

"Our midwives are promoting natural, vaginal births wherever possible. It's why we like to focus on more women giving birth in our community clinics.

"The women feel more at home there and the recovery after a natural delivery is much, much quicker than a C-section."

MAny other factors also contributed to the low caesarean rate, Ms Stratton said.

"Counties Manukau has a younger population giving birth than in other regions like the North Shore.

"Maternal age is definitely reflected in the figures, there are more complications in pregnancy and labour when the mother is older."

Ms Stratton also said the figures reflected a lack of involvement in the conception and birthing process from fertility clinics or private obstetricians.

"People who've had IVF obviously want to be really sure they are getting a healthy baby at the end of the process. Many of them feel that can be achieved by having a C-section.

"We don't have IVF babies born here, it comes back to the clientele we have in our district."

Although reporting low figures, the DHB was unlikely to fall in line with the World Health Organisation's recommended rate for caesarean deliveries of 15 per cent of all births, Ms Stratton said.

"Fifteen per cent is a very low number. Obviously that guideline fails to take into account the various populations of the world.

"For us our core philosophy has always been midwife-driven, that's not going to change.

"We feel satisfied we are only providing caesarean surgeries when there is an indication for them."

Obstetrician David Bailey agreed and said the WHO guidelines were impossible to assess at face value.

"Making comparisons between places is meaningless. The average population of the world is not the same. I think you can see that in Auckland with the variety of figures produced by the different DHBs.

"There are different socio-economic groups, differences in the age of mothers giving birth, and differences in philosophy. It's impossible to put one figure on it."

He said caesarean statistics needed to be evaluated carefully.

Caesareans

* 2009: National Women's Maternity Unit and Auckland Hospital: 31.2 per cent of total births.

* 2009: Waitemata DHB: 27.3 per cent of total births (includes Waitakere maternity unit and North Shore maternity unit).

* 2009: Counties Manukau DHB: 17.08 per cent of total births.

- Source: ADHB, WDHB and CMDHB