A Review of Primary Caesarean Sections in Tasmania

Abstract

In the years 1975-1982 inclusive there were 55,095 deliveries in Tasmania and of these 2,738 patients (4.9%) were delivered by primary Cesarean section. The primary Caesarean section rate increased from 4.3% in 1975 to 6.6% in 1982. This increase has been due to the increased incidence of primary Caesarean section associated with breech presentation and to a lesser extent fetal distress. Although the overall perinatal mortality rate fell from 19.5 per 1,000 births in 1975 to 10.8 per 1,000 births in 1982, there has been no corresponding fall in the perinatal mortality rate associated with primary Caesarean section. As an increase in Caesarean section will lead to an increase in maternal mortality and morbidity it is considered that an active review of the reasons for the rise in Caesarean section should be undertaken by those hospitals where the rate is unusually high.

Caesarean Section in South Australia, 1986

“…Rates have varied between countries from as low as 3.6% in the Netherlands in 1978 (4), to 13.1% in Scotland in 1981 (5), and to 22.7% in the USA in 1985 (2). Figures from Australia and New Zealand confirm the increasing trend in Caesarean birth rates during the last 2 decades with rates in some centres now around 19% (6)(7)(8). Since the Perinatal Statistics Collection of maternal and perinatal data for all births was commenced in South Australia in 1981, Caesarean section confinement rates for the State have gradually increased from 16.9% in 1981 to 19.0% in 1986 (table 1).…”

“…Numerous explanations have been offered for this change in obstetric practice. They include: the reluctance of obstetrics to deliver breech babies vaginally or to perform mid-forceps deliveries because of the apparent increase in risk to the fetus (2,6,8,9); the view that vaginal delivery following previous Caesarean section is unnecessarily risky, although this view is now being challenged (1,6,(10)(11)(12); the increasing use of electronic fetal monitoring which increases the chances of detecting as well as overdiagnosing fetal distress (2,3,13); because of changing childbearing patterns, the significant increase in the proportion of elderly primigravidas who have an acknowledged obstetric risk (2,14); the fear of malpractice suits, especially where there is public awareness of the apparent hazards of vaginal breech or mid-forceps deliveries (3,9,14); and finally, the request of the woman for a Caesarean section in the absence of strong clinical indications (15).…”