Figures show disparity between public and private Caesareans

Tue, Nov 13, 2012, 00:00

Analysis:The latest Hospital Inpatient Enquiry report on activity in Irish public hospitals shows a continuation in the significant numbers of women undergoing Caesarean section here.

Of the 71,000 women who gave birth in 2011, more than one-quarter had Caesarean deliveries.

The figures also show a disparity between public and private patients: some 25 per cent of women who delivered and who were treated on a public basis had a Caesarean section. Of these Caesarean section deliveries, 46 per cent were elective.

For women who delivered on a private basis, 36 per cent had a Caesarean, of which almost two-thirds were elective.

While there can be little controversy over the need for an emergency Caesarean section where the life of a mother or her baby is in danger, the same cannot automatically be said about a planned or elective operative intervention.

Many are indeed necessary, such as in a woman whose pelvic size means she is likely to run into difficulty delivering naturally or in the case of a mother whose blood pressure was elevated during pregnancy.

Too-posh-to-push culture

But the suspicion of a “too-posh-to-push” culture among private patients will not be helped by the finding that more than 22 per cent of women treated privately in 2011 had an elective section compared with 11.5 per cent of those treated publicly.

Reasons cited for the rise in Caesarean section rates include a greater percentage of older women having babies, fear of patient litigation and the better detection of foetal distress.

However, a section poses a greater risk to the mother: she is more likely to suffer a pulmonary embolism, which is when a clot travels to the lungs from a thrombosis in the leg; develop an infection of the wound; or experience problems associated with an operation that involves a longer recovery period.

Obstetricians do not accept the “too posh to push” phenomenon exists here.

They believe the key to reducing the number of sections is in how a woman’s first labour is managed.

If this can be managed without complications there is a much lower probability of an operative delivery.

Meanwhile, there has been a significant reverse in the number of private patients treated in our acute public hospitals. Public patients accounted for 83 per cent of total discharges in 2011. This represents a 7.5 per cent drop in private patients discharged from hospital in the period from 2007 to 2011.

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