KEY POINTS:
National Women's Health has been told women should be sent home if their labour is not fully established - to help reduce the risk of caesareans.
The leading Auckland maternity hospital has also been advised that more women should be moved to low-tech primary birthing facilities such as
Birthcare Auckland if they are expected to have a straightforward delivery.
The advice is from Dr Sally Pairman, the Midwifery Council's chairwoman and head of midwifery at Otago Polytechnic, who compared the outcomes for low-risk women at National Women's and Birthcare.
She found the rates of epidural pain relief, birth interventions and bleeding were all higher for those who initially booked into National Women's.
Advocates of a more natural approach to birth care say one intervention makes the next more likely, a "cascade" that starts with an epidural or medicine to induce labour and which ends in a caesarean.
New Zealand's caesarean rate has steadily increased from 11.7 per cent in 1988 to 23.7 per cent in 2003.
National Women's rate last year was 33.1 per cent among women of all levels of risk.
Dr Pairman said that if women were admitted to a high-tech hospital such as National Women's before their labour was properly established they were at risk of staff interfering medically to speed things up.
She said that because large hospitals had such an array of medical technology and expertise they tended to use it, even when not needed. Its use then became virtually the norm. National Women's higher use of epidural pain relief might be a reflection of this. She wants more primary maternity units built, separate from base hospitals.
"Across New Zealand we should have a system where women who have normal pregnancy and birth are expecting to give birth in a primary unit. Probably a lot of our intervention rate is because we are mixing primary, secondary and tertiary services in one facility which is completely dominated by the needs of tertiary."
Counties Manukau has three primary units owned by its district health board; Auckland City has just one, owned privately.
National Women's general manager Kay Hyman said the hospital could not encourage women to deliver at Birthcare. That was a decision for women and their lead maternity caregivers, mainly private midwives or obstetricians at National Women's, to make. But a number of women were sent home if their labour was not fully established.
Women are permitted to choose where to give birth and the state pays. Some low-risk women are thought to choose National Women's because they perceive it to be safer.
Around 300 women gave birth at Birthcare's Parnell unit in the past financial year and the company expects the figure to nudge 500 this year.
INTERVENTION RATES
* Among low-risk patients who started their first birth at Birthcare Auckland last year, 80 per cent had a straightforward vaginal delivery.
* For the comparable group in National Women's at Auckland City Hospital, 55 per cent had a straightforward delivery.
* Emergency caesareans: National Women's 20 per cent; Birthcare 8 per cent.
* Epidurals: National Women's 64 per cent; Birthcare 29 per cent.
* Episiotomies: National Women's 30 per cent per cent; Birthcare 10 per cent.
* Note: All figures are for low-risk women having their first birth. All the caesareans and epidurals occurred at National Women's, including transfers of Birthcare patients.
