Birth in NSW Today

For further information, contact Melissa Maimann at Essential Birth Consulting. In the past ten years or so, a lot has changed Australia-wide when it comes to birth. Focusing solely on NSW, the latest (2006) report paints a grim picture of birth in this State.

Since 1996, the caesarean rate has increased a whopping 64%. The caesarean rate was a mere 16% in 1990, rising to 17.6% in 1996. It is now 29%.

In 1999, 22.5% women had a VBAC. By 2006, this figure was down to 12.7%, with some hospitals having VBAC rates of a mere 2%.

In 1996, 23.1% women had an epidural or a spinal. In 2006, this figure was 43.5%.

In 1996, 70.7% women had a normal vaginal birth. This figure fell to 60.4% in 2006. Some private hospitals have normal birth rates of 32%. It makes you wonder what is "normal" in those hospitals. That hospital in particular has a caesarean rate of 45.3%. Maybe we need to re-define normal birth. In contrast, another hospital has a normal birth rate (as in, a normal vaginal birth) of 93.4%. It makes you wonder what is possible, given the right information, support and care provider.

Publicly-funded women had the following outcomes in 2006:

Normal birth: 67.1% Assisted vaginal birth: 8.2% Caesarean: 24.3%

Privately-insured women had the following outcomes in 2006:

Normal birth: 48.9%, 37% lower than publicly-funded women Assisted vaginal birth: 14.5%, 77% higher than publicly-funded women Caesarean: 36.4%, 50% higher than publicly-funded women

In 1999, 0.6% babies were stillborn, and 0.3% babies died shortly after birth. In 2006, 0.6% babies were stillborn, and 0.3% babies died shortly after birth. Those figures remain unchanged, despite our ever-increasing rates of intervention. The perinatal death rate per 1,000 births remained stable between 2002 and 2006: 2002 recorded 8.7 deaths per 1,000 births; 2006 reported 8.8 deaths per 1,000 births. No babies died in home births in 2006. The most common cause of neonatal death was extreme prematurity. Between 1990 and 1996, the perinatal mortality rate decreased from 10.4 to 8.9 per 1,000.

Looking now at maternal mortality (indirect and direct causes), in 1990, this figure was 11.6 per 100,000. The figure came down to 9.0 per 100,000. Because these numbers are so small, when we look at the stats for individual years, we see that the rate fluctuates from 4.7 to 11.6 per 100,000. Maternal mortaility is generally analysed in trienniums to try to even out these differences. The average maternal mortality between 1990 and 2005 is 8.1 per 100,000.

Looking now to home birth statistics, we see the following results:

Transfer rates range from 43% to 22%, depending on the criteria for home birth. The transfer rate is 12% - 20% for privately-practicing midwives. You need to remember that this figure includes women who transfer in pregnancy - eg for high blood pressure, placenta praevia etc. Most transfers were not in labour. Many of the women who transferred achieved a vaginal birth in hospital. Normal birth rates range from 82% 94% Assisted vaginal birth rates range from 3% to 4% Caesarean rates range from 5% to 14% VBAC rates range from 65% to 85% Episiotomy rates range from 2% to 4% Stillbirth + Neonatal death rates range from nil to 2.3 per 1,000, and one study even found a death rate of 9 per 1,000.

Midwifery care has several advantages

Less likely to be hospitalised during pregnancy Less likely to have an epidural Less likely to have an episiotomy Less likely to have an assisted vaginal birth More likely to have a natural labour and birth More likely to feel in control during labour and birth Higher breastfeeding rates More likely to report a high level of satisfaction with the care and the outcome You will have autonomy You will have choice and control over what happens to you and your baby You will be a partner in your care

So .... where will you have your baby? Who will you choose to be your care provider? Be sure to employ a private midwife if you choose to have your baby in hospital.

Melissa Maimann, Essential Birth Consulting 0400 418 448