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Health Ministry releases maternity services report


Ministry of Health releases maternity services report

The number of women having caesarean section births in New Zealand hospitals is increasing, a Ministry of Health report on maternity services shows.

Report on Maternity 2000 & 2001 is the second report analysing comprehensive maternity services information.

It shows that in 2001, 22.1 percent of hospital births were by caesarean and 10.3 percent involved operative vaginal procedures such as forceps. Just under 70 percent of hospital births were normal vaginal deliveries.

Ministry of Health principal medical advisor Dr Rob Buist said today that rates for caesareans continue to show slight increases.

In 2000, 20.8 percent of hospital births were by caesarean, with 20.4 percent in 1999, 19.2 percent in 1998 and 18.2 percent in 1997.

``This trend is consistent with caesarean rates in the United Kingdom, Australia and the United States,'' Dr Buist said.

He believes the increasing caesarean rate is due to the perceived safety of the operation -- a perception reinforced by some studies supporting caesarean births over natural labour in a number of circumstances, such as breech birth.

``However, caesareans are associated with greater short-term risks than vaginal birth -- infection, bleeding and clots. Risks related to second or subsequent caesareans can include considerable haemorrhage and increased risk of emergency hysterectomy at the time of delivery,'' Dr Buist said.

``A caesarean section that has been pre-arranged is safer for mothers than an emergency caesarean, although there is a small risk of breathing difficulty for babies. This risk increases the earlier the operation is done.

``A caesarean is an important clinical decision and women and their caregivers need to have the best quality information regarding choices around childbirth. The Ministry and other sector groups such as the New Zealand Guidelines Group are working to make sure this happens.''

Dr Buist said the Ministry had funded the Guidelines Group work on caesarean section, and the first two guidelines for clinicians -- on breech birth and birth after caesarean section -- would be released shortly.

The Ministry was also continuing to improve the quality of maternity outcome data through the Maternal and Newborn Information System.

Dr Buist said currently there is no good evidence to suggest large numbers of caesareans were being performed for no medical reason, although the 2000 & 2001 report does not include reasons for caesareans.

The report also highlights a positive trend of falling rates of hospital stillbirths and deaths in the babies' first week of life. Dr Buist described this as pleasing, because it indicates that overall New Zealand's maternity services are safe.

The report shows that in 2001, for every 1000 live births, nine babies died. This compares with a rate of 10.2 babies per 1000 live births in 2000, and 10.7 babies in 1999.

The most common cause of stillbirths and early deaths related to babies being born early. Dr Buist said that in 2000 and 2001, 6.1 percent of babies were born before 37 weeks of pregnancy, compared with 7.2 percent in 1999.

Other points of interest in the report include: In 2001, 53,805 women gave birth in a hospital to a total of 54,288 babies. Statistics New Zealand recorded 56,224 registered births for 2001, indicating 3.4 percent of babies may have been born outside of hospital. While the breastfeeding status of 36 percent of babies is unknown for 2000 and 2001, report data shows that in 2001, 67.7 percent of women were exclusively breastfeeding at the time of discharge from maternity care, compared with 71.7 percent in 2000. The increase in caesarean sections was for all groups of women -- those with their first baby, second or subsequent babies, previous caesareans, breech babies, premature babies and those being induced.

Background Report on Maternity 2000 & 2001 is the second in a series to analyse New Zealand maternity services. The information is useful for district health boards (DHBs) when they are considering maternity services and outcomes within their region. It will also help DHBs when preparing needs analysis.

The report should also interest lead maternity carers (LMCs), health professionals, policy makers, academics and consumers. It allows LMCs and maternity institutions to benchmark their services, compare their practice with their colleagues and to make international comparisons.

To view this report online, go to the Ministry's website: http://www.moh.govt.nz


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