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Birth outcomes in NSW

A closer look at the birth outcome statistics for New South Wales (2003) reveal some interesting facts and confirm what has been proven by previous analyses. In simple terms, if you want to have a great birth with a minimum of interference, choose a country hospital and use the public health system. Avoid a city hospital, especially if it is a teaching hospital and don’t choose private care at a private hospital unless you are prepared to pay for it, with your dollars and also your body. A few figures will explain these statements.

The best hospital for normal natural birth in 2003 was Wyong, just north of Sydney. This unit is run by midwives and some selection criteria apply, but once accepted you have a 92.1% chance of a straightforward, uncomplicated birth. It could be argued that this outcome would be expected under these conditions, and that any other result would be unacceptable, but it does prove that the majority of women, when cared for by midwives, do well during labour.

Other hospitals, without the ability toscreen their clients, have also done well. Armidale Hospital (77% normal birth rate) and Kempsey (77.6%) stand out but smaller hospitals in the Northern Region also achieved high rates of almost 80% uncomplicated births.

Some city hospitals did well too. The western suburbs of Sydney, an area where many migrants and poorer people live stood out: Fairfield (71.6%) Canterbury (71.4%) , Auburn (78.8%) and Camden, which is again under threat of closure, had a normal birth rate of 85%. All of these hospitals can handle emergency caesareans and all, except Camden, are teaching hospitals. There will be very little private obstetric care in these units and they are good indicators of a public system that is working well.

At the other end of the scale are the private hospitals. These places should hang their heads in shame - their clients are from the wealthy end of town, well nourished, healthy and with few underlying health problems. Yet they achieve deplorable birth outcomes: Hurstville Community Hospital (43.8%) and Kareena Private Hospital (38.5%) take top honours here, with the majority of their clients (44% at Kareena and 37.4% at Hurstville Community) having a caesarean birth. This is outrageous and gives a good indication of the risks that come from choosing obstetric care - only an obstetrician can do a caesarean!

The larger Regional referral hospitals don’t do so well either, but they will have a higher than average number of women with problems, especially if the system is working as it should and those with complications are referred for specialised care. The figures from Bathurst Base Hospital (59.6% normal births and 34.2% caesareans) and Goulburn Base Hospital (53.4% normal births and 28.4% caesareans) illustrate this point. These figures for caesareans are still high, according to the WHO, who say that even if all the women admitted to the hospital had complicated pregnancies the caesarean rate should be no more than 15%. I suspect it is once again the presence of obstetricians in these centralised referral units that tip the balance towards surgical birth, even when it may not be absolutely necessary. Next, I’ll have a closer look at the rates for epidural and drug use in labour.

Posted by andrea at January 27, 2005 07:08 AM