Dramatic rise in caesareans

Last updated 10:28 16/08/2014

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A culture of fear around childbirth is gripping women and forcing rates of medical intervention to the highest this country has seen, experts say.

One in every three births at National Women's Hospital in Auckland is now done by caesarean section, a new report reveals - and rather than being too posh to push, clinicians say some women are simply too scared. 

The Maternity Services Consumer Council are calling for the induction and c-section rates for individual doctors to be published, in an effort to drive numbers down.

It is also galvanising to screen documentary Microbirth in cinemas nationwide, which says modern birth practices - like induction of labour and caesarean sections - can lead to weaker babies who are more open to disease later in life.

Figures released this week show in 2013, there were 7,337 babies born in Auckland Hospital, and 34.7 per cent were delivered by caesarean section. At Wellington Hospital, the rate was 31 per cent.

The latest Ministry of Health figures put the national rate at 25 per cent, which is also rising every year. The WHO's recommended target is between  10 to 15 per cent of births.

Auckland Hospital obstetrician and gynaecologist Dr Michelle Wise said the rising rates were concerning and ''any intervention at all'' was not ideal.

One reason was the rise in older women becoming pregnant, which led to more complications. Statistics NZ figures released show that last year, for the first time, more women became mothers between the ages of 35 and 39 than those aged 20 to 24.

But more women were opting to have a caesarean, she said.

''We would hope that women were making an informed choice, so that they know the risks of having major surgery. But we also do know there are some women who really do just fear childbirth and the pain associated with it and they do want to protect their vaginal wall. We don't advocate it.''

But Maternity Services Consumer Council co-ordinator Lynda Williams said the latest rates were shocking and some obstetricians were known for performing planned c-sections, no questions asked. ''Women know where to go to, the maternity grapevine works very well.'' Publishing numbers for individual doctors would help to stop this, she said.

Home Birth Aotearoa trustee and midwife Sharon Knightbridge said half of her job was convincing women that childbirth was not a medical emergency. As more women waited till their thirties before having children, birth was thought of as less natural.

''The first baby they might pick up might be their own, so there's there is this culture of fear that grows around birth. We try and spread the word that what you see on TV, which is screaming and pain, isn't what it's like.'' Home birth was increasingly becoming a less-frightening option for women, she said.

Microbirth, which would screen in 700 cities nationwide in September including City Gallery in Wellington and Berkeley Cinema in Auckland, says c-sections prevent healthy bacteria transferring from mother to child and leads to more diseases later in life. 

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Malaghan Institute gut immunologist Dr Elizabeth Forbes-Blom said it was true that the way a child was delivered shapes the ''microbiota,'' a collection of micro-organisms that live in the gut.

And studies have shown children born by c-section might have an increased risk of non-communicable diseases - but more research was needed before a direct link was made. 

''We're not saying c-sections are bad, but we aso know there's data coming together that there might be unintended consequences. I think we've got more work to do to say it's a cause and effect thing.''

Ministry of Health principal maternity advisor Bronwen Pelvin said rising rates of caesarian section were an international issue.

Factors influencing the rate of increase in Caesarian sections include older women giving birth and increasing complications of pregnancy, such as gestational diabetes. 

Each district health board had a Maternity Quality and Safety Programme, and could use this to work towards decreasing their rate of caesarean sections.

- Stuff


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