WUNRN
Australia: Mothers'
Wishes, Legal Fears Push Up Caesarean Birth Rate
Carol
Nader
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".
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