Slowdown sought for caesarean birth rates

National Women's Health has turned its spotlight on the high rate of caesarean births by private obstetricians looking after pregnant women.

Its 2004 clinical report shows a stabilising of its overall caesarean rate in the past three years at around 29 per cent after years of rises. National Women's is usually several percentage points ahead of the New Zealand average.

But even "low-risk" women having their first babies had a 34.6 per cent caesarean rate when they used private obstetricians. Nearly a quarter of those caesareans were prearranged "electives".

For these women, the private obstetricians' caesarean rate was significantly higher than when the lead carer was an independent or hospital midwife. The obstetricians also performed operative vaginal births at a higher rate.

Cindy Farquhar, professor of obstetrics and gynaecology at National Women's, said of the private specialists' rate of intervention: "It does seem high".

But two other obstetricians approached by the Herald did not think it unduly high.

Dr Geoff Bye, a director of the Auckland Obstetric Centre, said the different rates were partly explained by midwives referring complicated pregnancies to private obstetricians or public hospital clinicians.

His clinic's rate of elective caesareans was much less than the 9.3 per cent among low-risk women giving birth for the first time.

Private obstetricians commonly charge women about $3500 in Auckland for a caesarean and related pregnancy care.

"They are older women, women of means, they know what they want," said Dr Bye. "They delay child-bearing till they're older."

Many were higher-risk patients, or they wanted a specialist after enduring care that was less than ideal in a previous delivery, he said.

His clinic was not keen on elective caesareans without medical need, but if the woman insisted, "you have very little option these days", because of the risk of recriminations if a caesarean was denied and the birth went awry.

"Surgery is not ideal. A lot of this is based on the flawed premise that intervention is necessarily wrong. Remember that intervention saves lives, both the mother and the baby, and reduces morbidity [illness]."

But Maternity Services Consumer Council co-ordinator Lynda Williams is concerned by National Women's declining proportion of straightforward births.

She said private obstetricians' intervention rates were too high and they tended to provide inadequate information about the risks.

Dr David Knight, the clinical leader of National Women's, said a measure being looked at to lower the caesarean rate was a clinic to encourage pregnant women who had had a caesarean to attempt a vaginal birth if considered safe.

Professor Farquhar said other strategies were for obstetricians to access figures on their own intervention rates; and to promote National Women's success rate in turning foetuses from breech to head first, reducing the likelihood of a caesarean.

INTERVENTIONS

Caesareans at National Women's

* 16.6 per cent of all births in 1991.

* 29.3 per cent of all births last year.