Drop in caesareans a tick for midwives

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A falling rate of caesareans at Wairau Hospital points to a good working relationship with Marlborough midwives, say obstetricians at the Blenheim hospital

Obstetricians Melissa Smith and Gary Fentiman said caesarean rates at the Blenheim hospital fell from 33 per cent of the 559 total births in 2010, to 29 per cent ...

The caesar rate was about average for New Zealand although national statistics had not been kept since 2007 ...

This caesarean rate sounds very high, considering most women in NZ choose a midwife as their lead maternity carer, and midwifery care is known to result in low caesarean rates.

Internationally, rates ranged from over 60 per cent in some parts of Brazil and 50 per cent at some United States hospitals, to below 1 per cent in third-world areas with a high death rate for labouring mothers and babies.

Another sign of success in the Wairau maternity department was an over-80 per cent success rate for women attempting a vaginal delivery after a previous caesarean.

Behind the healthy statistics was good communication and mutual respect in the maternity team, the obstetricians said. "The patients are well-managed by their midwives with our back-up," ...

... Only rarely did Marlborough women demand a caesar with no attempt at vaginal delivery although this trend was showing up in cities, the obstetricians said.

During six months at Wairau, about six expectant mothers had walked through Dr Smith's door asking to book a caesarean.

After reassurance, four went on to have vaginal deliveries, one required a caesarean and one was still pregnant.

When a woman demanded a caesar there was always a story; a bad experience in the past, advice from a friend, sister or mother leading to fear and lack of understanding, she said.

... Dr Fentiman said midwifery had been the victim of some media-bashing since Government introduced the lead maternity carer model in 1996.

... In Marlborough, self-employed midwives care for pregnant women with back-up from hospital obstetricians who attend complex births and are on-call if needed.

Obstetricians see pregnant women whose births might not be straightforward, to help plan their labour.

Of labours expected to be trouble-free, about 30 per cent are attended by an obstetrician who provides help ranging from advice through to performing a caesarean ...

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