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Giving birth in South Australia

The report from South Australia on Pregnancy Outcomes for the year 2003arrived on my desk today.

The statistics reveal that for the third year in a row there was a fall in women having normal spontaneous births, and this rate now sits at 58%. The Caesarean rate has climbed to 30% (13.3% of these were elective procedures) and the VBAC rate was a paltry 20%. Almost all pregnant women (96%) had at least one ultrasound in pregnancy, and 50% had their labours either induced or augmented. The percentage of induction done for other than medical reasons has rapidly increased from 35% in 1998 to 44% in 2003. The episiotomy rate was 13.3%.

The table showing rates for analgesia was interesting. A third of women received no analgesia at all during labour, which is a remarkable figure. Narcotics were used by 26% and epidurals for labour pain by 31.9%. Nitrous oxide was used by 35.8% (some women will have used more than one type of analgesia).

Fetal monitoring also showed some interesting results. External fetal monitoring was used by 52.2% of women, but 40% had no electronic monitoring at all during labour (presumably they would have been monitored by Doppler or Pinards instead).

Several birthing units (often called midwifery led units in the UK) have been established in SA. For the women who planned to give birth in these units, only 51.1% achieved this goal, with 48.9% being transferred to the labour wards before the birth. This would include women who developed problems in the pregnancy, and would not be the numbers transferred during labour, however this still remains unacceptably high. Of those who were transferred, 26.9% eventually had a caesarean birth and 15.9% had instrumentals deliveries.

The number of homebirths has risen in the past two years, having dipped since 1981 and there were 60 planned homebirths (0.3% of all births) during 2003.

This report doesn’t give the detail that is available in the similar NSW report and it is difficult to get the figures for individual hospitals, except for the five metropolitan maternity units in Adelaide. Of these, it is clear that The Women’s and Children’s Hospital, which now uses a team midwifery model for all its clients, has generally better outcomes than the other hospitals. Since this report was prepared more women will have had the opportunity to experience midwifery care, and the figures for the coming years will reveal any improvements that theoretically should flow from this development.

Posted by andrea at August 30, 2005 04:10 PM