Maternity hospitals dictate method of delivery

A woman’s choice of maternity hospital may dictate the type of labour she has as latest figures show a wide variation in medical intervention rates in the country’s maternity hospitals.

At St Luke’s Hospital in Kilkenny, 38% of births were by C-section, making it the highest rate in the country and double that of the lowest — 19% at Sligo General Hospital.

Nationally, the C-section rate stands at 26%. The Association of Improvements in Maternity Services (Aims) who obtained the C-section figures under Freedom of Information legislation said this was well above the 10%-15% recommended by the World Health Organisation.

However, UCD professor of Obstetrics and Gynaecology, Michael Turner, said the WHO figures were “over 25 years old” and the organisation’s position now was that the optimum C-section rate is not known.

Prof Turner, who was speaking on RTÉ radio, said the national rate was “not a worrying figure” and that it compared favourably with other European countries.

The National Maternity Hospital at Holles St had a rate of 21.52% rate, while at Cork University Maternity Hospital the figure stood at 28%. The Coombe had a similar C-section rate of 27.58%. At the Rotunda, nearly a third of births are by C-section.

However, Prof Turner said varying rates between hospitals was “well described internationally” and that issues such as case complexity — including obesity, maternal age (which is on the increase), and multiple pregnancies due to IVF — were likely influences. Staffing issues and differences in clinical practices also had a bearing, he added.

Episiotomy rates are also markedly high in this country. An episiotomy is a surgical cut to the muscular area between a woman’s vagina and back passage.

Clinical guidelines in the UK list routine episiotomy as a “do not do”, according to Aims.

The highest episiotomy rate in the country is at Holles Street, at 27%. At CUMH , the rate is 19%.

The figures also show that up to 18% of CUMH births involve the use of surgical instruments such as forceps or ventouse (suction). However, a total of 54% of women give birth without any instrumental aid. CUMH has 60% of new mothers breastfeeding when leaving hospital, a high rate compared to other Irish hospitals.

Dublin’s Rotunda has a breastfeeding rate of 62%.

Breastfeeding rates fall as low as 38% at Limerick Regional, Maternity.

Co-chair of Aims Ireland, Krysia Lynch, has that said the statistics once again demonstrate the need for an overhaul of maternity care in Ireland. Aims wants an end to obstetric-led care in favour of more midwife-led care, such as takes place in Britain.

Ms Lynch said that evidence showed the large majority of women benefit from a midwifery-led care model.

“Obstetric-led care has a very important place in Irish maternity services and should be available for women who want or need this type of maternity care,” said Ms Lynch.

“However, in failing to provide evidence-based care options, valuable resources are being over-utilised as women have no option but to give birth in under-staffed and overcrowded consultant led units.”

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