HEALTH SERVICES
Intervention rate high in first-time mums
March 25, 2014
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First-time mothers in Ireland are much more likely to end up undergoing some sort of intervention during the birth of their child, including a caesarean, than women who have had children before, figures from the HSE have shown.
The HSE released detailed figures of birth statistics from the country's 19 public maternity units, following a request by AIMS (the Association of Improvements in Maternity Services). The figures refer to 2012.
According to AIMS, the data reveals ‘a stark contrast in the level of interventions that a first-time mother experiences compared to women who have given birth previously'.
The figures reveal that 40% of first-time mothers attending St Luke's Hospital in Kilkenny ended up having a caesarean compared to 36% of women who had given birth previously. The figure of 40% was the highest caesarean rate in the country for first-time mothers.
The second highest was in Mayo General Hospital, Castlebsar, where 37% of first-time mothers gave birth via caesarean. This was significantly higher than the 28% of mothers who had given birth previously.
Other hospitals with big differences in their caesarean figures included Wexford General (27% of first-time mothers versus 21% of women who had previously given birth), the National Maternity Hospital in Holles Street (26% versus 20%) and Limerick Regional (34% versus 28%).
In almost all of the maternity units, the caesarean rate among first-time mothers was higher than the hospital's overall caesarean rate. The biggest gap was in Castlebar, where the overall caesarean rate was 31% compared to 37% in first-time mothers.
The rate of instrumental deliveries, i.e. the use of forceps and vacuum extraction, and the use of episiotomies, were also much higher among first-time mothers.
An episiotomy is a surgical cut that is made to a woman's perineum - the area between the opening of the vagina and the anus (back passage). It used to be relatively common in childbirth as doctors believed it could benefit the woman by, for example, reducing the risk of more extensive vaginal tears during childbirth.
However, research has shown that this is not the case and the procedure should only be carried out in certain circumstances, for example, if the baby is distressed and needs to be born quickly, but the vagina is not stretching enough to allow this.
The figures revealed that in Castlebar, 14% of all women giving birth required an instrumental delivery. Among women who had given birth previously, this figure was 8%. However, among first-time mothers, this figure jumped to 27%.
In University College Hospital Galway, 35% of first-time mothers had an instrumental delivery compared to just 9% of those who had given birth previously. The overall instrumental rate was 19%.
When it came to episiotomies, the National Maternity Hospital in Holles Street had an overall rate of 22%. Among women who had given birth previously, this figure was 9%. However among first-time mothers, it jumped to almost 40%.
In Mullingar General, the overall episiotomy rate was 19%, however, this jumped to 35% in first-time mothers compared to just under 11% in those who had given birth previously.
The figures also revealed a low number of mothers who had previously had a caesarean section going on to have a vaginal delivery on a subsequent birth. In Castlebar, Letterkenny General, Mullingar General and Portlaose General, no women in 2012 were listed as having had a vaginal delivery after a previous section.
This compared with the National Maternity Hospital in Holles Street, where 33% of women who had previously had a section went on to have a vaginal delivery, 22% in the Coombe Maternity Hospital, 20% in Waterford Regional and 17% in South Tipperary General in Clonmel.
Krysia Lynch, co-chairperson of AIMS, expressed concern about some of these figures.
"In the first instance, the rates of interventions to first-time mothers are worryingly high. It points once again to the inappropriateness of a consultant-led care model for healthy, low risk mothers. There is no medical reason for such high levels of intervention and the effects of these interventions on first-time mothers will influence the outcome of any future pregnancies they may have," she insisted.
She said that the low number of women going on to have a vaginal birth after a previous caesarean indicates that ‘women are not being supported by their local maternity unit to have a vaginal birth if they so wish'.
"Our own national obstetric guidelines recommend that a woman should be referred to a consultant or unit who is prepared to facilitate her request. There are obviously care provider barriers here that need to be addressed," Ms Lynch added.
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