Greetings from down under down under.
There is an example of a primary facility in New Zealand where only elective
caesarean sections are performed. It is the only one in the country.
Essentially the hospital has a primary maternity unit (no on site obstetric
or paediatric back up) sited within a private surgical and medical hospital.
In an analysis of the 1999 birth outcomes document produced by our Ministry
of Health available under 'publications' on www.moh.govt.nz , the following
may be of interest to those foolish enough to think that providing
'accessible' intervention will not impact on their increasing use.
1. The region (one of 21 regions in the country) had the highest private
obstetric consultation rate at 22.5 per 100 deliveries compared with the
national average of 7.8.
2. The lowest normal birth rate in the country at 59.6% compared with the
national average of 68.7%.
3. The highest elective c/s rate in the country at 11.5% compared with the
national average of 7.1%
4. A total c/s rate of 23.4% compared with the national average of 20.4%
5. An epidural rate of 32% compared with the national average of 22.8%
6. The highest readmission rate for newborns of 126.4 per 1000 hospital live
births compared with the national average of 71.0.
7. The primary maternity facility had a c/s rate of 45.8%.
8. Even the tertiary facility had the lowest normal birth rate of all
tertiary facilities in the country at 54.6% compared with the average of 62%
(these births exclude those in the private hospital!)
The region in question has about 5000 births per year.
I hope this helps inform your decision. Personally, I believe that the
further away intervention is from health women, the more likely they are to
experience a normal birth. Interestingly we have a good number of women in
the country who birth in primary maternity facilities (there are 55 of
them), which are mostly located in rural towns, about an hour from the
nearest intervention. I have a paper being published in the next NZ College
of Midwives Journal (April) on research carried out looking at the
functioning of these facilities.
I am beginning to think, that all birthing should occur away from
intervention, unless the woman is identified as requiring it. There should
be a few strategically placed 'high dependency unit' style birthing units
and most women directed to their local low/no intervention birthing unit
physically located distant (in no way connected physically) from the HDU or
better still, stay at home and make the birth a family event!.
Best wishes in your search for the ideal solution.
Chris Hendry
----- Original Message -----
From: Margaret McGuire <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, February 21, 2003 1:04 AM
Subject: elective caesarean sections in community maternity units
Colleagues apologies for cross posting, some advice would be really
welcome.
At present there are a number of maternity units under threat largely
due to paediatric staffing issues. In an attempt to maintain a limited
service (as well as maintain a facility for caring for low risk women
(community maternity unit) some are considering having an elective
caesarean section facility in Community maternity units which are
alongside general hospitals. Is there any evidence for or against low
risk Elective C/S being carried out in CMU's ? My understanding is
that all midwives will have the NLS courses and women suitable for this
will be carefully vetted. Now I know some of you will question this,
but think remote and rural and trying to make a service as accessible to
as many women as possible.
Mags
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