Risky Deliveries for Healthy Mums

Reports about the latest release of the Ministry of Health’s ‘Maternity Clinical Indicators’ suggest that either; reporters and some consumer organisations do not understand the origins and meaning of these ‘indicators’, or they have no concern for the welfare of healthy, first-time mothers and their babies?

The various rates of different childbirth interventions reported last month by the MOH, including Cesarean section rates, are the outcomes ONLY for women who are ‘standard primipara’; that is they are healthy, first-time mothers “aged between 20 and 34 years at the time of birth in a hospital or birthing unit”, whose birth of a single, head first baby at term followed a pregnancy with no  “recorded obstetric complications that are indications for specific obstetric intervention.”  The healthy circumstances of these women means they are amongst the most likely individuals who should have had a normal or natural labour and birth. Or as this report says, this group should have had “low intervention and complication rates ………… consistent across hospitals”.

However, the report states, for example that during 2010 in New Zealand hospitals;

  • only 50.6% to 85.5% of all the healthy, first-time mothers in their local DHB had a Vaginal delivery (which may have been induced and, or augmented).
  • from 4.4% to 23.5% of all the healthy, first-time mothers in their DHB had an Instrumental delivery.
  • from 8.5% to 25.9% of all the healthy, first-time mothers in their DHB had a Cesarean section.
  • only  16.7% to 58.3% of all the healthy, first-time mothers in any DHB had an Intact Perineum.

Thus this report shows that; “Common interventions used during (‘normal’) childbirth include: induction, epidural, episiotomy, manual removal of placenta and the management of postpartum haemorrhage”, happen to healthy, first-time mothers birthing in New Zealand hospitals, at different rates depending on who is caring for them.  This most recent MOH maternity report is NOT about the percentage of ALL women undergoing each or only one intervention in each DHB in 2010, for example cesarean delivery as suggested by the media response.

Unlike the UK there is no MOH collecting or reporting the numbers (or percentages) of women who labour and birth their babies naturally in any New Zealand maternity unit, whether they are having their first, or a subsequent baby.  Thus the Maternity Manifesto is seeking government and community support for “Labour and birth which starts, progresses and ends naturally to be the New Zealand definition of “normal birth” and the gold standard or goal for maternity services quality assessment”.

The approximately 5% of New Zealand women who currently birth at home each year, begin and end their labours naturally. This is because there is no capacity or desire for any of the aforementioned interventions to happen, or be treated at home, except for an episiotomy. However this latter possibility is not even hinted at on home birth websites, nor is it usually necessary when women birth gently and instinctively  under the influence of their birth hormones, rather than be told what to do by others.

Uninformed Maternity Media and Commentators.

The medical language and statistical format of this MOH report makes its meaning and significance unclear to many people. Thus “Jenn Hooper, spokeswoman for ‘Action to Improve Maternity’, slammed the results and review as meaningless saying  ”With cesareans, unless they are actually leading to a lot of deaths do we actually care?” . However those who know about maternity care issues and research are very concerned about the costs to individual women, babies, families and our society including the health budget, of inappropriately high and rising levels of traumatic birth events, in an otherwise healthy population.

The websites and other activities of many consumer organisations, both here and in other countries such as the UK, Australia , USA and Canada aim to reduce escalating childbirth interventions, as well as to support women and babies who have suffered through these traumas. Rising rates of Cesarean section in Australia have birthed a network of consumer organisations dedicated to addressing the misinformation around this procedure, as well as contributing to many national and state enquiries into reform of Australian maternity services. A prominent obstetrician and past President of the Australian Medical Association, has acknowledged in a national paper that the rising rates of post cesarean hysterectomies (removal of a woman’s womb) are one negative consequence of increased surgical deliveries.

Babies, families and communities also suffer when women have unexpected interventions in their births, for example studies have shown that obstetric interventions in birth increase the rates of breastfeeding failure and post-natal depression even in under-developed countries. Hospital and family resources need to be increased to meet the extra care, both phyical and emotional of women who are birth injured. These are some of the reasons why the Royal College of Obstetricians is encouraging healthy women in the UK to birth at home or in a primary birthing unit (also called a midwifery led units or birth centre).

Meanwhile, every-one in the UK and on the world-wide-web can access the rates of the aforementioned interventions for each maternity unit, each year in England, Scotland, Wales and Northern Ireland. Increasing the home birth rate is also a national goal of each country’s health service in the UK. Surely New Zealand families deserve to have a maternity service which similarly prioritises accountability and the healthiest outcomes for the majority of its population?

New Zealand families and the community also need investigative journalists to present balanced and knowledgeable analysis of their health services and its outcomes rather than sensationalist reporting or poorly informed stories which only increase the paralysing, socially created fear of childbirth that evolved with medicalised maternity care last century.

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The greatest joy is to become a mother; the second greatest is to be a midwife. — Norwegian proverb
Without deviation from the norm, progress is not possible. — Frank Zappa
All change is not growth, as all movement is not forward. — Ellen Glasgow
Birth is not only about making babies. Birth is about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength. — Barbara Katz-Rothman
Trust children. Nothing could be more simple, or more difficult. Difficult because to trust children we must first learn to trust ourselves and most of us were taught as children we could not be trusted. — John Holt
A loving heart is the truest wisdom. — Charles Dickens
We need to have their hearts before we can open their minds. — Dr Gordon Neufeld
I can promise you that women working together - linked, informed and educated - can bring peace and prosperity to this forsaken planet. — Isabel Allende
Nothing in life is to be feared it is only to be understood. Now is the time to understand more so we can fear less. — Marie Curie
No other natural bodily function is painful and childbirth should not be an exception. — Grantly Dick-Read