Caesarean Section Rates, Australia 1986: Variations at State and Small Area Level

EDITORIAL COMMENT: This paper presents important data regarding Caesarean section rates in the various Australian States and Territories according to metropolitan or nonmetropolitan area and whether or not the patient was medically insured or was a private patient. The different rates between the States are less than the differences between insured and uninsured patients. High Caesarean section rates increase the hospital costs of obstetric practice although it should be noted that the average number of days in hospital in Australia, after either vaginal or Caesarean delivery are about double that in the United States of America, where the Caesarean section rate exceeds Australia's ‐ but then the Caesarean section rate in China exceeds America's by a similar margin to that which the USA's rate exceeds that in Australia! What are the reasons for the very high Caesarean section rate in this nation where most women have only one confinement? Surely what needs to be settled is whether these higher Caesarean section rates are necessary ‐are we practising good medicine? Does the alarming increase in the Medical Defence Association rates for obstetricians contribute to defensive medicine and earlier decision to perform Caesarean section and satisfy the woman and her partner when the going gets tough in labour. It may be noted that 47% of all patients' claims against doctors in Victoria involve obstetricians. Patients expectations of a favourable outcome for mother and child are increasing, especially as the new technology is viewed as a guarantee of normality. Readers are referred to previous papers and comments on this subject. Summary: The first national study of Caesarean section rates was made possible by combining 1986 data from hospital morbidity collections and medicare claims. Rates per 100 births, based on the area of usual residence of the mother, were calculated for statistical local areas, which were aggregated to statistical subdivisions, statistical divisions and States. The rate for mainland Australia was 16.9% (Tasmania could not be included). Variations in rates were of the order of one and a half‐ to two‐fold. The highest rates were found in Canberra and central Brisbane (26.3% and 25.4% respectively). The rates for Northern Territory, South Australia, and Queensland were higher than those for other States. There were few consistent patterns in the variations. Generally rates were highest in the State capital cities and for insured women. This suggests an association with the supply of obstetricians and with demand factors such as the expectations of obstetricians and consumers.