1)  There was no suggestion let alone reference, or hint by TVNZ of growing international evidence and experiences which show that a surgical delivery has more risks for both mother and baby compared to a vaginal birth, in all the examples to which they referred. However the viewpoints offered by TVNZ about those situations suggest that Caesarean delivery is an equal, acceptable or even better birth option for these mothers and their babies. 

2)  The need to section all breech babies has been disputed by large international studies, and in 2007 it was stated “there is not enough evidence to support cesarean section as the method of choice for delivery of (preterm and term) breech”, as suggested by the TVNZ report. More recently international conferences to inform and teach Vaginal Breech Birth skills to maternity care providers have been organised, including one in Sydney by Women’s Health Care Australasia.

3) Also contrary to the highest standard of evidence, TVNZ suggested, through the personal endorsement of a woman, that surgical delivery for twins is the ‘best’ birth outcome for mother and babies!

4) Most recently in Australia, Midwifery Prof Hannah Dahlen has refuted pronouncements by the current RANZCOG representative blaming older and fatter pregnant women for rising C/S rates in Australia. Still pregnant women getting older and fatter is sited as a cause of the rising C/S rate by the TVNZ report. However a scan of the 2010 NZ Report on Maternity would suggest otherwise; for example “caesarean section decreased with level of socioeconomic deprivation, ranging from 28.9% for the least deprived women to 19.4% for the most deprived women” (a group with more obesity problems). A previous blog showed that according to 3 recent  NZ Maternity Clinical Indicator reports on the birth outcomes of healthy first-time mothers, the NZ hospital in which a woman labours influences her chances of  a caesarean delivery. Thus the Maternity Services Consumer Council researched and produced a leaflet specifically for NZ women about C/S. This leaflet quotes Michel Odent that; “the primary reason for the increasing rates of intervention certainly is a quasi-cultural and universal lack of understanding of the basic needs of women in labour.”
5) The TVNZ segment was incorrect in portraying Dr Emma Parry as representing the Royal College of Obstetricians, rather she is an Auckland based surgeon and therefore probably a member of the Australian- New Zealand college, whose representatives recently voice non-evidence based opinions on this issue in the Australian media.

6) The Royal College of Obstetricians in the UK has, since 2009 been actively involved in campaigns to reduced rates of C/S and raise the level of “normal” birth in the UK. Both these valid endeavours currently appear not to be of political interest or concern to RANZCOG members, who TVNZ references.

7) The TVNZ segment made no reference to the increasing number of New Zealand women who are having post caesarean hysterectomies (11 in 2012), as subsequent C/S risks include still-birth, placenta accreta or percreta (due to placental embedding in the uterine scar) and coagulation disorders which creates a need for emergency hysterectomy. These outcomes, related issues and debates are getting an airing in the Australian news media, but not in NZ!

8) TVNZ made no mention, let alone representation by any women who have been traumatised by their caesarean deliveries, such women have been instrumental in forming organisations like TABS or online post caesarean support groups.

9) The financial cost was mentioned as $5,000 for each C/S, at 1 in 4 births per annum this equates to about $75 million each year. Using the latter figure may have raised some response of concern from the economically driven national government,  about any negative impacts of this growing rate on the NZ community? ?

10) Why was there no comment from a midwife or their professional body, especially as TVNZ introduced the segment as about ‘a surprise to researchers who thought the switch to a midwife-led maternity service from a medical-led service 20 years ago would have slowed down that growth’, which was 11.7% in 1989 prior to this change.

I think the subject of this news segment, with or with-out its inaccuracies should pre-empt a national enquiry into this issue and its impacts on the New Zealand community? Perhaps, the next government may look at the evidence and ask women how to  reduce the level of surgical interefrence in the births of their babies?