Caesareans In Childbirth

Newcastle Herald

Tuesday January 15, 2008

LEADER

Caesareans in childbirth

THE medical profession has been instrumental in converting the perception of childbirth from a natural event requiring intervention only on relatively rare occasions to one where significant medical involvement is considered normal.

Now that medicalised childbirth and its complications are consuming increasing amounts of the health budget, the profession wants to turn back the clock.

Caesarean sections now account for about 30 per cent of childbirths in Australia, up from an estimated 5 per cent in the 1970s. Most of these procedures are unnecessary and it is increasingly apparent that the extra workload on surgeons and hospitals can be accommodated only by reducing resources available for other patients.

There are now calls for a campaign to encourage women to return to conventional birth, but this will take a determined and co-ordinated effort. Many Australian women are now accustomed to the idea that they can decide when their babies will be delivered and like the relative absence of pain and discomfort that caesarean sections promise.

During the 1980s it was found that the biggest predictor of whether a woman would have a caesarean was private health insurance, leading to the assumption that remuneration for surgeons was a signficant factor in the decision. These days the fear of litigation may be just as big a consideration, with caesareans seen as the safe way out for surgeons who can find themselves facing lawsuits when things go wrong in a conventional birth.

It is notable that complications associated with caesareans are increasing. Dangerous cases of placental adhesion to scar tissue left by past surgical incisions, for example, are reportedly on the rise.

A more rational approach to childbirth is needed. Common sense suggests that most women should expect to give birth normally with little more than monitoring and the assistance of a midwife team. Interventions such as caesarean sections should be reserved only for cases where they are clinically required.

Health funding

THE Rudd Government has begun to deliver its promised $600 million for public health across Australia, with a first instalment of $150 million earmarked to cut elective surgery waiting lists. As the most populous state and the state with one of the worst waiting list problems, NSW has received $43.3 million.

Population has emerged as one of the most significant factors in the allocation of the funds, a simple approach that has avoided the usual noisy brawling by states clamouring to persuade the Commonwealth of their special needs.

It seems likely that some of the remaining promised funds will be conditional on greater accountability and administrative reforms such as the elimination of cost-shifting practices from the hospital system.

Labor has a good opportunity use its dominance of federal and state government to achieve reforms in important areas such as health funding.

Early signs suggest that it intends to take advantage of this rare chance.