60% of planned caesareans performed before 39 weeks without medical indication – Australian Atlas of Healthcare Variation Series 2018
The Third Australian Atlas of Healthcare Variation 2018 has been published. The report explores variations in healthcare across Australia investigating unwarranted variations and providing actions to reduce variation.
The report this year has looked at neonatal and paediatric health amongst other topics including information on early planned caesarean sections without a medical or obstetric indication. The Atlas highlights recent research showing increases in both short-term and long-term effects for children born via caesarean section before 39 weeks. It is the recommendation of certain organisations and Australian states to wait until 39 weeks gestation if there are no medical reasons for earlier birth. Data of sufficient quality was available from 4 states on the topic.
The atlas found that:
‘between 42% and 60% of planned caesarean sections performed before 39 weeks’ gestation did not have a medical or obstetric indication, and between 10% and 22% of caesarean sections performed before 37 weeks did not have a medical or obstetric indication.’
The rates were generally higher for privately funded patients compared to publicly funded.
There are 7 recommendations in the atlas relating to early planned caesarean section without medical indication including:
The full list of recommendation and the remainder of the atlas can be view here.
Labour outcomes in caseload midwifery and standard care: a register-based cohort study
A study has been published by BMC Pregnancy and Childbirth looking at labour outcomes in caseload midwifery. The study conducted in North Denmark looked at births allocated to caseload midwifery over a 3 year period. Out of 13,115 births there were 2679 allocated to caseload midwives.
Findings of the study include:
The study concludes:
‘We found that most outcomes were equal across models of care but there seemed to be a small but unexpected finding of more augmentation and adverse neonatal outcomes in caseload midwifery.’
The full study can be read here.