Dear Chris
Thank you very much for this useful information.
Best wishes
Belinda
--- hendry <[log in to unmask]> wrote: >
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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