Drop in caesareans a tick for midwives

PENNY WARDLE
Last updated 13:00 26/07/2011
Dr Gary Fentiman and Dr Melissa Smith
DEREK FLYNN/Marlborough Express

GOOD RESULTS: Wairau Hospital obstetricians Dr Gary Fentiman and Dr Melissa Smith say they have good communication with midwives in Marlborough.

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A falling rate of caesareans at Wairau Hospital points to a good working relationship with Marlborough midwives, say obstetricians at the Blenheim hospital

Obstetricians Melissa Smith and Gary Fentiman said caesarean rates at the Blenheim hospital fell from 33 per cent of the 559 total births in 2010, to 29 per cent from January-June this year. About half were emergency caesars and the rest were anticipated.

The caesar rate was about average for New Zealand although national statistics had not been kept since 2007, Dr Fentiman said. Internationally, rates ranged from over 60 per cent in some parts of Brazil and 50 per cent at some United States hospitals, to below 1 per cent in third-world areas with a high death rate for labouring mothers and babies.

Another sign of success in the Wairau maternity department was an over-80 per cent success rate for women attempting a vaginal delivery after a previous caesarean.

Behind the healthy statistics was good communication and mutual respect in the maternity team, the obstetricians said. "The patients are well-managed by their midwives with our back-up," Dr Smith said.

A caesar could be essential for the mother and baby's health. However, less acceptable reasons were lack of trust in midwifery care or impatience from the mother, her supporters or birthing professionals. Only rarely did Marlborough women demand a caesar with no attempt at vaginal delivery although this trend was showing up in cities, the obstetricians said.

During six months at Wairau, about six expectant mothers had walked through Dr Smith's door asking to book a caesarean.

After reassurance, four went on to have vaginal deliveries, one required a caesarean and one was still pregnant.

When a woman demanded a caesar there was always a story; a bad experience in the past, advice from a friend, sister or mother leading to fear and lack of understanding, she said.

A lot of clinic time then went into offering reassurance.

Dr Fentiman said midwifery had been the victim of some media-bashing since Government introduced the lead maternity carer model in 1996.

A lack of comprehensive maternity statistics since midwives replaced doctors as lead carers, meant there was no meaningful stick in the sand against which to measure progress made. Good statistics were a useful tool, he said.

With three fulltime obstetricians at Wairau Hospital, he hoped there would be more time for collecting and analysing statistics on birth management so outcomes could be constantly improved.

Dr Smith, who has worked a locum at Wairau since February, leaves for Australia next month for another temporary position.

Dr Smith's locum position will be permanently filled by obstetrician Melissa Scalera.

Dr Fentiman is a permanent on Wairau's obstetric team which he joined as a locum in September, but home is still Dunedin where his family lives.

MIDWIVES IN MARLBOROUGH

In Marlborough, self-employed midwives care for pregnant women with back-up from hospital obstetricians who attend complex births and are on-call if needed.

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Obstetricians see pregnant women whose births might not be straightforward, to help plan their labour.

Of labours expected to be trouble-free, about 30 per cent are attended by an obstetrician who provides help ranging from advice through to performing a caesarean.

Women who go into labour when they are less than 35 weeks pregnant are referred to larger hospitals, if possible.

- The Marlborough Express

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