pregnancy

The race to cut c-section rates is having dangerous side effects.

A push to reduce the rate of caesareans has had negative consequences where women are being forced into long labours risking severe medical complications or death.

Last year the World Health Organisation (WHO) warned that caesarean sections should only be performed when medically necessary and be no more than about 10%-15% of all births. Above that rate, the WHO data showed there is no evidence of improved mortality.

Ten years ago, Australia’s caesarean rate was 19% today it was 32% – many experts say that our caesarean rate is climbing due to the increase in age of mothers, and an increase in obesity but others blame the medical professionals themselves saying that fear of litigation is what drives doctors to encourage the surgery. (A notion rejected by leading doctors.)

Ten years ago, Australia’s caesarean rate was 19% today it was 32%. Image via IStock.

However a renowned gynaecologist has analysed data out of the UK showing that the push in both the UK and Australia to reduce caesarean section rates is misguided and may be putting women and their babies at risk of avoidable injury and death.

Professor Hans Peter Dietz, University of Sydney professor of obstetrics and gynaecology analysed the rate of trauma using data from Britain’s National Health Service.

As reported by The Australian he has made a submission to the NHS’s maternity review showing the use of forceps during vaginal births could lead to serious injuries to a woman’s internal organs.

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Professor Dietz’s team showed 81 per cent of women who had a forceps delivery suffered damage in this category.

Professor Dietz’s research has found that the potential fallout from an attempt to reduce caesarean section rates included increasing rates of maternal pelvic floor tears from forceps deliveries, postpartum haemorrhages as a result of long second-stage labours, and uterine ruptures in vaginal births after previous caesarean deliveries.

The push to push is misguided. Image via IStock.

“The relentless pressure to ­reduce caesarean section rates has, according to our modelling at my unit at the University of Sydney, resulted in over 100,000 ­excess cases of major maternal trauma to the pelvic floor and anal sphincter in England since 2005 due to the increase in forceps alone,” he told the review.

Professor Dietz has previously noted that while countries such as Denmark, Sweden and Germany had almost completely abandoned forceps in favour of vacuum extraction, their use was growing in parts of Australia.

In NSW, forceps-assisted deliveries in public hospitals accounted for 4.3% of births in 2012, up from 3.1% in 2008.

The Australian writes that the Royal Hospital for Women in Randwick rates of forceps use have climbed to more than 10 per cent.

“The major medical concerns of morbidity and mortality have been superseded by a new performance indicator, to reduce C-sections at all costs,” said Professor Dietz.

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He said it was “crazy.”

“Due to the rise in forceps rates in NSW, about 1000 additional women may by now have suffered avoidable, often incurable pelvic floor trauma”, Professor Dietz told the Medical Journal of Australia last year.

“This is highly clinically relevant, putting women at risk of later prolapse and incontinence”, he said. “We can no longer ignore this particular outcome of childbirth.”

Both planned vaginal and elective caesarean births had good outcomes for Australian mothers and babies. Image via Istock.

Dr Michael Permazel from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists told SBS last year that doctors only advise c-sections when they feel it is the safest mode for a woman and her baby.

“The most important thing which tends to be forgotten is that women are realizing that if the risk of something going wrong could be avoided by c-section, then they’re very keen on doing the best possible thing for their baby.”

He agreed with Professor Dietz that arbitrary targets for caesarean section rates could be harmful.

“The tacit implication that caesarean section is unsafe or less desirable may be misleading”,he said reassuring Australian mothers that both planned vaginal and elective caesarean births had good outcomes for Australian mothers and babies.

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