Normal Births are Becoming Less Frequent
22 January 2002
Maternity Report 1999: Normal Births are Becoming Less Frequent
There are fewer normal births according to a Ministry of Health annual report on maternity services, released today.
Report on Maternity: 1999 shows 20 percent of hospital births were by caesarean and 11 percent involved operative vaginal procedures such as forceps. Less than 70 percent of hospital births were normal vaginal deliveries.
Ministry of Health principal advisor Dr John Marwick said Report on Maternity: 1999 contained comprehensive information on women who gave birth in 1999 and the results.
He said one issue of interest the report highlighted was that the rate of interventions during labour was high. The 1999 national rate for caesarean births was 20.4 percent. In 1998 the rate was 19.2 and in 1997 it was 18.2.
"These high rates of caesarean are of concern. Caesarean births carry a higher risk of complications for the mother and although they can often save babies when there are problems, experts are generally agreed that national rates over about 15 percent offer little extra advantage."
Report on Maternity: 1999 showed 52,428 mothers gave birth in a hospital to a total of 53,273 babies. Statistics New Zealand recorded 57,053 registered births for 1999 indicating nearly 7 percent of babies may have been born outside of hospital.
Dr Marwick said the report was pleasing in that it showed overall, New Zealand's maternity services were safe.
"The rate of hospital stillbirths and deaths in the first week of life is 10.7 per 1000 births. This appears to have been stable over the past three years. "
"While international comparisons are difficult because countries use different definitions these mortality rates appear to place us tenth among 25 OECD (Organization for Economic Cooperation and Development) countries."
Dr Marwick said stillbirths and early deaths were often related to babies being born early.
"The report shows that 7.2 percent of babies were born before 37 weeks of pregnancy. This is a reduction from 7.4 percent in 1997 and compares favourably with the United States (11.8 percent) and Australia (7.4 percent).
Dr Marwick said future reports would help ensure maternity services were being monitored. He hoped the information collected would be used by practitioners to improve the services and their outcomes.
For more information contact: Hayley Brock Media Advisor (04) 496 2115, 025 495 989 http://www.moh.govt.nz.html
Why is this the first Maternity Report? National data on some aspects of maternity have been collected for many years.
An annual report is published on fetal and infant deaths by the New Zealand Health Information Service which can be found at: http://www.nzhis.govt.nz/publications/Fetal.html In 1999, the Ministry of Health released Obstetric Procedures 1988/89 - 1997/98, which can be found under Publications on: http://www.moh.govt.nz.html
Maternity Report: 1999 is the first time data collected from practitioners' payment claims have been matched with information from national hospital data. This combined data is known as the Maternal and Newborn Information System (MNIS). This report is the first annual report from the MNIS and is more extensive than any previous report.
Some aspects of the data are incomplete because of present maternity payment arrangements. As a result, the non-hospital data used in the report covers only 70 percent of births. Changes being discussed at present will allow the MNIS to include data from all births in the future.
Other points of interest within the report
The report shows marked differences between hospitals in the number of caesareans. Of the five largest maternity hospitals (National Women's, Middlemore, Waikato, Wellington, Christchurch and Dunedin), Middlemore Hospital recorded 16 percent of its babies were delivered by caesarean, while Waikato Hospital's rate was 31 percent. Similar differences are noted between provincial hospitals with Whakatane and Masterton reporting the lowest rates while Southland and Palmerston North have the highest.
Dr Marwick said these differences could not be fully explained by variations in the populations served; they also reflected differences in clinical practices. He expected that the data would lead hospitals and clinicians to carefully reassess their current practices.
There are regional differences in other aspects of birth. Forcep rates are unusually high in Masterton and Christchurch but low at Middlemore and in Whakatane and Greymouth.
Over the whole country 28 percent of births were induced. In hospitals the rate ranges from 17 percent in Masterton to 45 percent in Nelson. In the five largest maternity hospitals the average induction rate was 34 percent of births. Dr Marwick said the differences in induction rates also reflect differences in clinical practice. He pointed out that high rates of induction are linked with higher numbers of caesarean births.
Epidural rates (a spinal injection to reduce pain) vary from more than 50 percent in Wellington and Blenheim to less than ten percent in Whangarei, Whakatane, Taranaki and Greymouth. Dr Marwick said differences in rates were partly due to variations in availability of anaesthetists however mothers' individual choices will have also affected the difference in rates.
The combined data in the report shows that in 1999, 66 percent of all births had a midwife as the lead carer. Twenty percent of women had a GP and 14 percent had a specialist obstetrician.
As would be expected, the report shows specialists care for more women who have caesareans and the mothers they care for have a higher rate of stillbirths.
However, Dr Marwick said in terms of interventions during birth and the outcomes, the overall differences between the three practitioner types was not great.
The report shows European and Pacific women are more likely to breastfeed than Maori and Asian women. Meanwhile, mothers in Northland and South Canterbury appear more likely to exclusively breastfeed their babies. Lowest exclusive breastfeeding rates were recorded in the Hutt Valley and Hawke's Bay.
Dr Marwick said this was the first time New Zealand had been able to analyse lead maternity carer breastfeeding data. However, the information should be interpreted with caution because, for 12,142 babies or 31 percent, the breastfeeding status was unknown. Better data is expected for future MNIS reports.