Australia has one of the highest C-Section rates in the world and has almost doubled since 1991. The World Health Organisation recommends C -Sections should only be performed when medically necessary. It has stated “there is no justification for any region to have higher caesarean rates than 10-15%”.
Out of 137 countries that report their rates, Australia’s is one of the highest, with 32 per cent of all births delivered through a caesarean section. Whats the stance of Obstetricians and Midwives?
Obstetricians and Midwives
“You can find a medical reason for anything,” said a spokesman from the Australian College of Midwives. “Whether or not it’s a good medical reason is the question, and a lot of pseudo reasons are being used to argue women into C-sections.”
One obstetrician opined there is a “downgrading of high risk patients, which is common in NSW antenatal care… The aim is to retain antenatal patients in midwifery run clinics and prevent obstetricians from getting involved.”
From my experience, the very real ‘tug of war‘ is part of the problem in the hospital system, which cares for expectant mothers, especially when the patient is on a ‘shared care plan‘ which means the patient sees her GP and midwives at an outpatient clinic, with the occasional obstetrician consult. Clinical opinions of obstetricians and midwives do vary, both through the antenatal stage and intra-delivery.
What To Look For?
In the clinical notes, there will be antenatal notes and clinical or progress notes during birth, which hold a wealth of information. What are some risk factors in the (antenatal and birth clinical notes) that would flag a ‘high risk patient‘ possibly requiring C-Section;
- increased age of the mother
- question of maternal pre-eclampsia being present
- maternal hypertension
- macrosomia ( very large baby)
- diabetes or heart condition of mother
- antenatal notes which state “obs and paed at delivery, pt warned of shoulder dystocia and complications. RV ob/gynae weekly” – Was that carried out?
- what, if any, discussions were undertaken with patient prior to delivery i.e. plan at delivery if complications arise and a C-Section is indicated, even though plan is for natural birth?
- prior complications in pregnancy or prior C-Seçtions
- position of the baby (head, bottom, body) i.e. breach or transverse
- low lying placenta (placenta praevia)
- lost baby in the past, either before or during labour
Emergency C – Section
An emergency C-Section is unplanned, following complicating events intra-delivery, which if not acted upon can cause major damage to either mother and/or child. Emergency C-Section may be indicated if:
- labour fails to progress, long and slow, after induction
- baby or mother develop a serious complication (not immediately life threatening) will be organised within a few hours
- baby or mother develop a serious complication during pregnancy or intra-operatively, that is life threatening to mother or baby, a C -Section will be organised within a very short period of time
- baby distressed during labour
- placental abruption
- heavy bleeding during labour
- umbilical cord slips through the cervix ahead of the baby which can cause hypoxia in the baby, resulting in brain damage.
Sometimes, the decision to operate (C-Section), which has its own risks, is based on information that is open to interpretation, or reflects the skill or experience of the obstetrician. This means that decisions can vary from hospital to hospital, and doctor to doctor.
However, if a patient is giving birth in a birthing suite at a hospital, under the care of midwives, the decision to have a C-Section may not be made available to that patient, which can be catastrophic if complications arise and an obstetrician isn’t consulted or called to assist with the complication, which can result in substantial damage to the mother and/or child. This is especially so, when a patient has been identified as ‘high risk’ during the antenatal period.
If there are no complications during pregnancy, a planned natural delivery will always be safer than a C-Section. There are times when the decision to perform a C-Section, is not clear-cut. It will be up to the patient and doctor to weigh up the risks and benefits of having a caesarean, and to decide what’s best for both mother and baby.
Of course, an Expert Obstetrician/Gynaecologist would need to be consulted on ‘liability’ and a report provided before proceedings can be commenced.
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