Childbirth intervention rates vary by up to 20%

 

RATES OF Caesarean and episiotomy can vary by up to 20 per cent in Irish hospitals, depending on where a mother gives birth, a new survey has found. The figures were released yesterday by Cuidiú, the Irish Childbirth Trust, at the launch of bump2babe.ie, an online consumer guide to maternity services in Ireland.

Conducted by Cuidiú and supported by the HSE and Citizens Information, the online survey was sent to Ireland’s 22 maternity units and comprised 400 questions. Hospitals were asked to share information on topics such as their rates of induction, Caesarean births and episiotomies during 2009.

Cuidiú has said while all of Ireland’s maternity units responded to the survey, some were unable to provide data in response to all of the questions.

Co-author of the guide and Cuidiú antenatal teacher, Niamh Healy, said the findings illustrate that not only is there inconsistent data keeping in hospitals but there is “a real lack of standardisation across the maternity services, with policies and practices varying from unit to unit”.

On the data gathered on the numbers of births where labour comes on spontaneously, South Tipperary General Hospital scores highest with 68.4 per cent of all labours not induced. Mount Carmel, the State’s only private maternity hospital scored the lowest with just 44.6 per cent of labours occurring without induction.

While the midwifery-led units (MLUs) in Our Lady of Lourdes Hospital in Drogheda and in Cavan General Hospital both record a spontaneous labour rate of 100 per cent, Healy says these hospitals only admit women who have gone into labour spontaneously.

On rates of spontaneous vaginal birth, where ventouse, forceps or a surgical procedure such as Caesarean section is not used, excluding the MLUs, mothers at Sligo General Hospital require the least intervention, with 68.7 per cent of all births being spontaneous, while mothers at South Tipperary Hospital receive the most intervention, with 52.3 per cent of all births assisted.

With a difference of more than 20 per cent in the rates of intervention between the two hospitals, Healy says hospital policy might dictate that interventions be used so that labour progresses at a particular rate, but “the body doesn’t always comply”.

“When hospitals are under time pressure and bed pressure, they need to keep women moving through. There is a little bit of a conveyor belt system,” she says.

“We would like to see more flexible maternity services, where there is more space for women to labour at their own pace and not according to the clock.”

Regarding Caesarean births, the highest numbers were performed in Mount Carmel, at 38.7 per cent of all births, and Kilkenny General, at 35.6 per cent of all births. Meanwhile, at Sligo General, just 18.9 per cent of all babies were delivered by Caesarean.

Looking at first-time mothers only, however, 43.2 per cent in Kilkenny underwent a Caesarean compared with just 22.1 per cent at the National Maternity Hospital.

Commenting on the fact that women can be up to twice as likely to undergo a Caesarean section depending on the hospital in which they give birth, Healy says: “Some of those [sections] have to have been unnecessary. If you are looking at other units, how can their rates be close to half that, without losing mothers and babies?”

On rates of episiotomy, outside of the MLUs where a negligible percentage of mothers require the procedure, Wexford General records the least number of episiotomies with just over 8 per cent of mums requiring it. The rate at the National Maternity Hospital, however, is more than three times that at 27.1 per cent.

Of the numbers of births where breastfeeding has been initiated within an hour, Mount Carmel scores slightly higher than both the midwifery-led hospitals in Cavan and Drogheda at 69 per cent of all mothers, while South Tipperary registers the lowest,’ with just 45.3 per cent of all mothers initiating breastfeeding within 60 minutes.

Of the numbers of mothers exclusively breastfeeding on discharge from hospital, the midwifery led-unit in Cavan scored highest at 60 per cent of all mothers. University Hospital Galway reported the lowest number of mothers exclusively breastfeeding on discharge at 31.7 per cent.

Commenting on the survey, Healy says, “These nationwide statistics highlight considerable variations in interventions practices, in particular, induction, Caesarean birth and episiotomy rates, where some maternity units have almost double the rates of others.”

She says she hopes the guide gives those parents recommended a particular course of action by a hospital “the confidence and empowerment to ask for the full range of options”.

To access the guide, visit bump2babe.ie.