A submission to a UK health review by Hans Peter Dietz, a professor in obstetrics and gynaecology at the University of Sydney, suggests that the push to drive down caesarean rates may be contributing to an increase in injuries to women during forceps assisted deliveries.
As reported by The Motherish, “Professor Dietz’s team showed 81 per cent of women who had a forceps delivery suffered damage. 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 preview caesarean deliveries.”
This begs the question, what are we doing to women in the race to cut the number of caesareans?
Professor Dietz’s submission said, “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 case of major maternal trauma to the pelvic floor and anal sphincter in England since 2005 due to the increase in forceps alone.”
The Motherish reported, “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 per cent of births in 2012, up from 3.1 per cent in 2008.”
There are a few reasonably uncontested facts that we should lay on the table here.
First, caesarean rates are on the rise in Australia. They’ve gone from 19 per cent to 32 per cent in the past decade.
Second, where a caesarean is not medically necessary, it’s probably better for a pregnant woman to attempt a natural birth.
Third, while cutting the caesarean rate is generally a good thing, there are risks associated with all delivery methods.
But it’s a real worry if statistics based on the general population have a negative impact on an individual labouring woman. Put another way, if the pressure on medical practitioners from population health advocates is impacting care decisions for individual women, that’s a potential problem.