As a recently released report shows, in a significant number of planned c-sections doctors are delivering babies via c-section before full term, without medical necessity.
According to findings in the Third Australian Atlas of Healthcare Variation, in 2015, between 42% and 60% of planned c-sections occurred before 39 weeks gestation.
Doctors Told To Stop Delivering Caesarean Babies Before Full Term
In the same year, between 10% and 22% of c-sections happened before 37 weeks.
None of these c-sections was done for a medical reason.
The report noted the rates tended to be higher in private hospitals (60%) rather than in public hospitals (52%).
What Is A Planned C-Section?
A elective or planned c-section occurs before labour has started.
Australia has a high c-section rate, with 1 in 3 women having the surgery.
This rate is higher than the level of c-sections recommended by the World Health Organization.
The WHO guidelines state countries should aim for a c-section rate of 10-15%.
The recommendation aims to maximise the benefits and minimise the risks of the surgery.
A planned c-section might be the safest way for your baby to be born, if:
- Your baby is in an abnormal position (or is one of multiple babies)
- You are pregnant with multiple babies and there are problems that indicate waiting for labour would not be safe
- The placenta is covering the cervix
- You have a health or medical problem that is life threatening for you or your baby.
These are medical reasons, which suggest the risk of a c-section outweighs the risk of waiting for labour to start.
However, there are also non-medical reasons why women have planned c-sections.
In these circumstances, the risks of major surgery to mothers and babies don’t outweigh the risks of waiting for labour to begin.
Some women are told they can’t have a vaginal birth after previously having c-sections.
Other women have elective c-sections because they wish to avoid vaginal birth or because it’s more convenient to plan around a c-section.
When Should A Planned C-Section Be Performed?
Leading health organisations recommend waiting until 39 weeks before a planned c-section is performed, if there are no medical concerns.
Planned c-section before 39 weeks increases the risk of problems for babies.
For example:
- Premature birth can occur if the estimated due date is wrong, or if the mother’s menstrual cycle is irregular.
- Babies can experience respiratory problems immediately after birth, which means a stay in a neonatal intensive care unit.
- There is increased risk of hospitalisation for infections in the first five years after birth.
- There might be longer term problems with development, poor school performance and increased risk of ADHD.
For more information, be sure to read What Are The Risks Of C-Section For A Baby?
What Does The Report Recommend?
The Australian Commission on Safety and Quality in Health Care produces the Atlas report.
The aim of the report is to explore healthcare across Australia, to identify variations and determine where healthcare needs improvement.
The Atlas report recommends doctors and hospitals gain fully informed consent from mothers about planned c-sections.
They would do this by discussing the risks and benefits of planned c-section before full term if there’s no medical reason.
The report also recommends hospitals and health service organisations regularly review and report rates of early planned c-section without medical indication.
This would help address the unnecessary use of these surgeries.
The Commission is also considering whether or not to include early planned c-section without medical need on the national list of hospital-acquired complications.
This list includes complications that occur as a result of hospitalisation.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends elective c-section only after 39 weeks, if there is no medical need.
Its president, Vijay Roach, however, said the Atlas report was a “guide not gospel” and a “cultural change” was needed to see fewer early planned c-sections.
