The SMH series sounding the alarm on rising rates of elective caesarean surgery also highlights some of the peculiar contradictions of our health system.
On the one hand, we can manage to provide costly and potentially harmful surgery to women who may not really need it.
On the other hand, we can’t manage to provide basic maternity care to many country women – it’s estimated that more than 100 rural maternity services have closed in the past decade.
As a result, stories can be told from right across the country of the mishaps, sadnesses and stresses that occur when women are forced to travel long distances in pregnancy and labour, and to separate from their families and other supports at such a crucial time.
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A few years ago, a review of Queensland maternity services found that more than half of rural and remote women who gave birth in that State in 2003 had to pack up and leave their families at 36 weeks.
Meanwhile in WA – where the mining boom is also swelling government coffers – the closure of Karratha Hospital’s maternity services for a few months last year meant expectant women had to fly out at 36 weeks to Port Hedland or Perth.
The dearth of culturally appropriate, local birthing services for Indigenous communities is also a disgrace. The consequences can be tragic when women avoid antenatal care and present late in labour to avoid having to leave home.
In the past, administrators have often used “patient safety” as an excuse for closing rural maternity services. But their rationale – that higher volume units provide safer patient care – was roundly rejected by a major study published in 2006.
It found that low risk women giving birth in smaller units were significantly less likely to be induced or to have other forms of intervention, and their babies were less likely to end up in specialist care and neonatal intensive care units.
The National Rural Health Alliance’s chair, Professor John Wakerman, observes a striking contrast between the problems of city and country women.
“It’s kind of ironic that there’s information coming out that high rates of interventionist obstetrics in larger metropolitan centres are seen as a problem and at the same time it’s very hard to keep open those small rural health maternity units where outcomes are good and women are able to stay in touch with family and social networks,” he told Crikey.
It’s also ironic that women are so often blamed for rising caesarean rates. This fails to acknowledge the many structural incentives promoting medicalised childbirth (that adage “you get what you pay for” is particularly relevant in health). Not to mention how the system routinely fails to ensure that patients are fully informed about all the potential benefits and risks of all their options.
The caesarean story is more than ironic, though. It’s a disturbing reminder that our health system is too often focused around the interests of providers (read those who make money from surgery and other procedures) rather than the well-being of patients and the broader community.