Two articles from Age re: c/s inc. comment from Lionel Steinberg
Here you go...
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Rise in caesarean births should be examined
May 31, 2007
MOST parties to the sometimes rancorous debate about women's birth practices agree that our high caesarean rates warrant investigation. But trying to unpack the trend, and its varied implications — be they for maternal and child health, doctors, insurers, the public purse and so on — tends to open a Pandora's box of dogma, prejudice, hyperbole and myth.
And so when another worrying statistic comes to light, as in a recent State Government report finding a rise in healthy young women undergoing caesareans in private hospitals, it inevitably provokes more questions than answers. Why are more than one in four young women in private hospitals undergoing a caesarean despite good health and uncomplicated pregnancies? The Department of Human Services figures show that the proportion of women under 35 who had a low-risk first pregnancy and went on to have a caesarean in a private hospital rose from 23.4 per cent in 2001 to 27.5 in 2005. The correlating rate in public hospitals has been a fairly stable 19 per cent since 2003.
Some doctors concede there may be more women electing for caesareans without medical reason in the private hospital system, but believe the overall number is small. And yet the "too posh to push" woman is regularly evoked in this debate, along with the obstetrician favouring surgery out of personal convenience. It's time to drop the caricatures and find the truth. Health Minister Bronwyn Pike said her advisory committee on maternity services would investigate whether hospitals with higher caesarean rates need extra help.
The report reiterates there's "no agreed or optimal or clinically appropriate (caesarean) rate," and experts caution against policies that would lead to different birthing options in private and public hospitals. We need to take this step by step.
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Mothers' wishes, legal fears push up caesar rate
Carol Nader
May 31, 2007
THE rate of caesarean sections is higher in private hospitals because women ask for them and because doctors are worried about being sued if a natural birth goes wrong, leading obstetricians say.
Of the women under 35 with uncomplicated first pregnancies who give birth in private hospitals, 27.5 per cent had a caesarean in 2005, up from 23.4 per cent in 2001.
For young first-time mothers giving birth in public hospitals, the figure has remained stable at about 19 per cent.
The obstetrics committee chairman at St Vincent's Private Hospital, Lionel Steinberg, said 5 to 7 per cent of women who had caesareans in private hospitals asked for them without any medical need.
"The reasons the caesarean sections have increased in first-time mums in the private sector are patient requests for caesareans, too many inductions of labour and the medico-legal risk related to each individual obstetrician in the private sector," he said. "In my practice, which is a low-intervention practice, there is an increased demand for caesarean sections … I spend a third of my time trying to convince women to give it a go naturally."
Dr Steinberg said women asked for caesareans because they feared labor pain, for convenience and because they thought it was safer. But it was not safer for the mother, as anaesthetics and surgery were associated with more risk, he said.
St Vincent's Private delivers about 3500 babies a year, more than any other private hospital. Its caesarean rate is 36 per cent. At Frances Perry House, another private hospital with a major obstetrics service, the rate is about 40 per cent. Obstetrician Ross Pagano, senior medical staff chairman at the hospital, said the higher rate was because women with more complicated pregnancies were referred to the hospital.
He said about 5 per cent of his patients asked for a caesarean. "An easy vaginal birth is very safe for the baby, but particularly in complicated cases caesareans are safer," he said. But Dr Pagano said a caesarean was not the safest option for mothers.
He said the increasing use of caesareans had nothing to do with doctors scheduling patients around their social calendars. "We get really annoyed when we read in the paper that obstetricians do caesareans because it's better for your golf game. It's absolute nonsense," he said. "We do caesareans these days because we want the best outcome … Nowadays, if a baby gets distress, even mildly, we will opt to get that baby out swiftly."
Dr Pagano said doctors were worried about being sued for problems, sometimes out of their control. He said some doctors had been sued for labours that had complications that "in retrospect could have been prevented by caesarean section".
