Curbs on caesarean access
Women wanting caesarean sections saw psychiatrists to prove mental health grounds for the surgery, as the country’s largest hospital tries to bring down numbers.
Auckland City Hospital has one of the highest caesarean rates in the country, and hospital bosses have identified private obstetricians as a factor, because their patients are much more likely to have the surgery.
It has blocked any more of the specialists from using its services, and put caesarean section requests from those with existing access under greater scrutiny, particularly earlier this year when capacity was needed in case Covid-19 broke out.
Some women ultimately got the surgery, but only after seeing a psychiatrist — a significant and costly step, and one that goes on their medical record.
The DHB has the backing of the College of Midwives, but Jenn Hooper, founder of Action to Improve Maternity, questioned the “obsession” with reducing caesarean rates when long-term outcomes should be the focus.
“Women should be absolutely free to make whatever decision, in a fully informed way, that they want to make. Alongside their practitioner, whoever that is.”
Elective caesareans (planned in advance of labour) accounted for more than one in five births at Auckland DHB last year, up from 15 per cent a decade earlier.
One reason identified by hospital management is patients who pay about $6000 for tailored, medical care and closer monitoring by a private obstetrician and their team.
Those in the public system get referred to an obstetrician if complications arise, but patients might deal with different doctors.
There is a lack of private birthing facilities, and for decades women looked after by private obstetricians have used Auckland DHB labour and birthing facilities, under “access agreements” with individual specialists.
For “low-risk” women giving birth for the first time at the hospital in 2019, the caesarean rate for those using private obstetricians was more than 50 per cent, compared to a national average of about 21 per cent, a paper recently presented to the DHB board noted.
About half the patients cared for by private obstetricians are NZ European, the report noted, compared to 2 per cent Ma¯ori and 2 per cent Pacific — groups at greater risk of problems like having premature or under-size babies.