Inadequate statistcs on births raises policy fears

THE huge differences in how hospitals record data on maternity services, highlighted by the Irish Examiner survey, raises serious questions as to how a national policy on obstetrics or gynaecology can be formulated, given the varying quality and quantity of statistics in existence.

It also points to different levels of intervention in a woman’s journey through the labour ward, depending on whether she is a private or public patient and, sometimes, on the quantity of experienced obstetric personnel available and the culture of a particular hospital.

One of the interesting facts to emerge was that, in 2004, Mount Carmel, a private hospital in Dublin, now owned by Harlequin Healthcare, had:

*The highest number of mothers aged 30-40+.

*The highest Caesarean section rate.

*The second-highest episiotomy rate.

*The highest epidural rate.

The high percentage of women who elect to have a section — 23% versus a national average of 12% — is a contributing factor to the overall rate of 37%. The older age profile of mothers may also be a factor.

The Mount Carmel figures substantiate the findings in the Irish Examiner survey published on Tuesday and Wednesday.

In other words, older mothers are more likely to have:

*Private medical insurance.

*Have a written birth plan.

*Have a planned Caesarean section.

*Have pre-planned pain relief.

*Have availed of pain relief during labour.

Unfortunately, the other private maternity hospital, Bon Secours Hospital in Cork, declined to participate in the survey, because “the statistics were not all collected in the detail required [by the Irish Examiner] and because the services will be transferring to Cork University Maternity Hospital in 2007”, according to a spokeswoman at the time.

Kerry General Hospital had the highest acceleration rate of the seven hospitals, and the highest ventouse (vacuum) delivery rate and lowest rate (one in four) of mothers continuing to breast feed after going home.

Waterford Regional Hospital had the highest induction rate (38%), compared with Wexford’s lowest rate of 8%, followed by St Luke’s, Kilkenny, at 13%. Incidentally, Waterford Regional Hospital also operates an Integrated Hospital/Community Midwifery Service, but the quality of data supplied for 2004 made it unsuitable for comparisons.

Over half the mothers in the University College Hospital Galway (UCHG) had an epidural, a similar rate to the Coombe Women’s Hospital in Dublin and Portiuncula Hospital in Ballinasloe.

One-in-three mothers in Mayo General Hospital and also in Sligo General Hospital had an epidural.

Cavan-Monaghan Hospital Group had the lowest episiotomy rate (9%) compared to one-in-four mothers in Kerry General Hospital and Mount Carmel. Cavan-Monaghan and Letterkenny General Hospital had the lowest forceps rate (0.4% and 1% respectively), compared to Sligo General Hospital’s 5%. St Luke’s Hospital, Kilkenny, had the highest ventouse rate of 14%.

“Research has shown that the use of epidurals does increase the instrumental rate,” said Professor Deirdre Murphy, Professor of Obstetrics and Gynaecology at TCD.

“Some 60% of first-time mothers have an epidural — that’s partly due to a demand from the women themselves, but it’s also because we induce labour in a quarter of women. They experience more intense pain with induction and Oxytocin, so they’ll ask for an epidural.”

The use of epidurals can also lead to a higher rate of forceps and ventouse rates.

Interestingly, most of the 15 hospitals which supplied data on other forms of pain relief adhere to the traditional methods, such as gas and air, pethidine, TENS and warm water baths, with just a few (Portiuncula, Kerry, Mount Carmel, WRH, Wexford, Our Lady’s of Lourdes Hospital, Drogheda) allowing for some or all of aromatherapy, reflexology, massage, birth balls, birth mats, reiki or yoga.

After Mount Carmel, one-in-three mothers in Portiuncula Hospital, St Luke’s Hospital, Kilkenny and South Tipperary General Hospital had Caesarean sections, with the average rate from all the hospitals falling to one in four.

The National Maternity Hospital in Holles Street came in lowest, with one in six mothers, followed by St Finbarr’s Hospital, Cork at one in five mothers. According to UCHG’s 2004 clinical report, its Caesarean section rate of 24% is undoubtedly high, but consistent with national and international rates for tertiary level hospitals.

However, the World Health Organisation recommends a rate of 15% (one in seven to eight mothers).

“Caesarean section rates have a lot to do with manpower,” said Professor Murphy. “If you’ve a small number of medical staff in a labour unit, you could hypothesise that they might make a decision earlier about a Caesarean section rather than monitor a labour for hours. If a hospital has an active management of labour culture, you may have interventions in terms of ruptured membranes or using Oxytocin, but they will use those interventions so as not to use a Caesarean section.”

More than half of the women who gave birth at Waterford Regional Hospital’s in 2004 were single, followed by South Tipperary General Hospital (43%) and Wexford (39%) and St Finbarr’s Hospital, Cork at 37%.

Mount Carmel had the lowest rate of teenage mothers (0.3%), followed by UCHG and the National Maternity Hospital, Holles Street (3%) but Wexford General Hospital was way ahead at 13% (one in eight).


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