February 08, 2003

Birth outcome statistics in NSW: Part 1

The NSW Mothers and Babies 2001 report has arrived on my desk. It makes fascinating, if alarming, reading as it details the birth outcomes, neonatal intensive care statistics and perinatal and maternal death statistics for the whole population of the State and for subgroups that live in out community. There is such a wealth of information here that it deserves several Diary entries which I will spread over the coming days.

The figures are compiled from the Midwives Data Collection form that is completed following every birth in the country. In 2001, there were 85,858 babies born to mothers with an average age of 29.9 years. About one in four mothers were born overseas. Over the preceding five years the number of women giving birth in birth centres fell from 4.6% to 3.4% and the number of planned home births decreased from 202 to 182 ( the number of unplanned home births was 297 in 2001).

The changing pattern of type of birth was clearly evident: in 1997 the normal vaginal birth rate was 70.4% and in 2001 it was 65.4%. Over this five year period the caesarean birth rate rose from 18.2% to 23.6% - the rate of vacuum and forceps births remained the same. For privately insured mothers the figures were worse: the normal birth rate decreased from 61% to 55.5% and the rate of caesarean birth rose from 22.2% to 28.2%. For women using the public health system the rate of normal birth fell from 75.4% to 71.8% and caesareans rose from 15.4% to 18.6%.

This increase in caesarean births is alarming. It has been climbing steadily at about .05% per year from some time but in these figures we see a sudden jump to a level that rivals the US and UK. The rate of prematurity increased as well - from 6.8% in 1997 to 7.2% and there was a slight decrease in babies born at 42 weeks or more. Only 44.4% of women in 2001 began labour spontaneously and 24.8% were induced, the remainder were either augmented (17.7%) or had elective caesareans (13%).

The disparity between private and public is also apparent when comparing other birth outcomes for the year 2000: forceps births accounted 3.6% for public patients and 6.8% for private patients; vacuum extraction was used for 5.1% of public patients and 8.9% of private patients; elective caesarean was used for 9.3% of public patients and 16.9% of private patients. Even emergency caesareans showed significant differences: 9.3% of public patients and 11.3% of private patients.

It is clear that maternity care is in chaos, starkly illustrated by these rapidly worsening outcomes for women and babies. These figures relate to the years before the Federal Government decided to encourage more Australians to use the private health system by subsidising the cost of private health insurance by 30%. It is already known that more pregnant women now use private health insurance to pay for their health care and that private hospitals are so heavily booked that some are only guaranteeing a bed if a woman is prepared to give birth on a chosen day (i.e. be induced). When the outcomes for these years are collated in the future, the writing will be very clearly on the wall: women and children are paying for the madness of the private obstetric system with its over-servicing and preference for scheduled, managed births.

As a taxpayer, I object to my taxes being used to underwrite this appalling apology for a health care system. I don’t want my money going to subsidise the rich who can afford health insurance and the private hospitals who are also allowed to dip into the public purse.

Pregnancy is the only health condition that a woman is encouraged to choose expensive specialist care as a first option. For all other health concerns, a primary care giver (GP) must be chosen first and a specialist will only be consulted if the primary care giver is unable to fix the problem. Midwives should be caring for pregnant women, as they are the appropriate primary care givers in this instance. Until this happens we will have birth outcomes that cannot be justified in any way, especially in a healthy, well fed, wealthy population such as Australia’s.

More on these statistics tomorrow.

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