September 01, 2003

Caesarean rate falling in Rockhampton

Today I have started another round of workshops within Australia before I head back to the UK at the end of the month. I am in Rockhampton, a major town about half way up the Queensland coast.

The midwives from the Base Hospital here were telling us about the changes going on, many of them the result of the crisis in professional indemnity insurance and the actions being taken by the doctors. There is only one obstetrician in town now offering private pregnancy care. The private hospital is having to switch from obstetrics to gynaecology as one result. It is interesting that the doctors are leaving obstetric practice because they are fearing litigation, yet the Tito Report on Medical Indemnity in Australia (released in 1994 and recently reviewed) clearly showed that 80% of cases brought against obstetrician/gynaecologists was as a result of their gynaecological practices. This makes sense when it is understood that the vast majority of pregnant women for whom they provide care are not sick, and the women seeking gynaecological treatments have a medical condition. Treating sick people must have higher risk factors than caring for basically healthy women (although many of them will join the ranks of the “sick” once obstetric care is unleashed on them).

Meanwhile, over at the Base hospital, their private obstetrician has left and the caesarean rate fell from 28% to 14% within a week. The Hospital administrators were already concerned about her high caesarean rate, which she stated was because of litigation. They will certainly notice the difference now that she is gone!

The midwives are coping with the extra clientele using the public Base hospital rather than the private hospital and their birthrate has climbed significantly. However, the staff obstetricians are feeling pressured and are trying to cope with their extra workload by ordering more inductions! Hard to see how this will help the situation, but I hope the midwives will draw the line at unnecessary inductions because of the added word this entails for them.

Interesting times, with lots of change going on. I am sure that I will find similar stories when I visit Orange in rural NSW next week.

Posted by andrea at September 01, 2003 06:38 PM

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