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Variation in Caesarean and Instrumental Delivery Rates in New Zealand Hospitals
Author(s) -
Johnson Neil,
Ansell David
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01821.x
Subject(s) - caesarean section , birth weight , scrutiny , obstetrics , medicine , variation (astronomy) , presentation (obstetrics) , perinatal mortality , demography , pregnancy , pediatrics , political science , fetus , sociology , biology , law , genetics , physics , astrophysics
EDITORIAL COMMENT: There is much data in this paper which we believe should interest readers. The policies established at Middlemore Hospital that have undoubtedly led to the reduction in the Caesarean section rate merit special scrutiny. We agree with the authors that a national perinatal database should be established in New Zealand. This will no doubt require regional centres to maintain their own statistics as is done in the various States in Australia. Hopefully perinatal mortality statistics will use the World Health Organization definitions namely that birth‐weight of 500 g or if birth‐weight is not known, birth after at least 22 weeks' gestation, becomes the criterion for inclusion. Readers should realise that the legal requirements for registration of perinatal deaths vary in different countries and are unsuitable for presentation of statistics. In Australia the statistical definition of neonatal death uses the 500 g birth‐weight criterion as for stillbirth, and includes all deaths occurring within 28 days of birth. If deaths occurring only within 7 days of birth are included this should be stated even although deaths occurring in the first 7 days outnumber those occurring from 8–28 days by about 4:1 (e.g. Victoria, 1992; 151:40 in 65,815 total livebirths).Summary: A study of Caesarean section and instrumental delivery rates in the maternity hospitals in New Zealand delivering over 1,000 women per year was undertaken. The results at Middlemore Hospital were compared with those seen elsewhere. The Caesarean section rate at Middlemore Hospital in 1993 was significantly lower than the other large maternity hospitals in New Zealand. The Caesarean section rate at Middlemore from 1988 to 1993 has shown a significant downward trend which is different from the trends at other hospitals. The spontaneous vaginal delivery rates at Middlemore Hospital were higher than at other New Zealand hospitals between 1988 and 1993. We conclude that Middlemore Hospital has been successful in maintaining low interventional delivery rates by New Zealand and international standards ‐ the Caesarean section rate remains below 10% and the spontaneous vaginal delivery rate approaches 85%. This is likely to be a consequence of a number of factors operating together but there is evidence to suggest that the obstetric management policies at Middlemore do play a role in this.