Reducing major surgery by 80%: why are surgeons not interested?

I’ve posted before about the C section escalation crisis and about some of the associated risks.

The Medical Journal of Australia describes “The first year of a midwifery-led model of care in Far North Queensland”. The paper outlines the experience of the midwifery-led birthing unit in Mareeba.

This midwifery model, even including intrapartum transfers in their data, achieved:

– an SVD (spontaneous vaginal delivery) rate of 91.5% (state average 61%)

– a C section rate of 5.6% (average 30.7%), an EIGHTY PERCENT reduction in major surgery

– an instrumental delivery rate of 1.8% (average 8%), another >80% reduction in a major intervention

– 72.7% rate of women birthing with NO injury to their perineum (state average is 36.3%): a doubling!

– episiotomy rate of 1.3% (state rate 12.4%): this is a 91% reduction in the number of women having their vagina and perineum cut open as they birth.

– a near doubling in the number of women birthing without pharmacological analgesia

– 89.2% of newborns required no resuscitation (compared to the state rate of 41.4%). Yes, nearly 60% of babies born in the obstetric machine are resuscitated. So much for “healthy babies” being what it’s all about.

– The average length of labour was under seven hours.

– The model was well supported by women, with very few choosing to transfer out.

There is simply no way to construe these differences as representing an “apples and oranges” situation. Fewer than ten percent of women had their care transferred antenatally to the Base hospital for medical reasons. Of these 16 “high risk” women, four presented to MDH in labour and gave birth without complications. Even if you assume that all 12 of the other transferred women had the full house of interventions (a faulty assumption) it wouldn’t get these stats anywhere near as high as state averages.

The Mareeba unit only re-opened after substantial community protest. This model of care remains under threat from obstetric lobby groups, with such programs being labelled “trial” and “pilot” groups. The language reminds me of the way that obstetricians label normal women’s bodies as deficient and suspect: “trial of labour”, “untested pelvis”, “dysfunctional uterine action”, “failure to progress”, “elderly primigravida”, and “vaginal bypass surgery”.

We can do better.

Categories: gender & feminism


9 replies

  1. those stats are phenomenal. it’s amazing what de-medicalizing the birthing process can do.
    i wonder if i could do a rotation there? it sounds like a phenomenal place . . .
    ladoctorita’s last blog post..things that are really upsetting me right now

  2. You could always apply, but there’s no way to know that this “trial project” will still be running. I know most of the teaching hospital take students from overseas on elective rotations, and you can always ask the smaller ones.
    There are heaps of elective options in Australia. You could do anything from a rotation up north or in the centre in an Aboriginal Medical Service, to a stint down south in the wine country or a beach town, and if you come to WA we could have lunch. I wonder whether the Flying Doctor Service takes students?
    Lauredhel’s last blog post..Reducing major surgery by 80%: why are surgeons not interested?

  3. What a great program. I hope that its funding survives.
    Having had an emergency caesarean, I’m glad the surgeon was there when I needed it. But the rate of elective caesareans, especially the pre-emptive caesareans where women who don’t want a surgical delivery are bullied into one, is just way too high.

  4. I’m always amazed at the people who argue against midwifery services, both hospital and homebirth, by saying “But it’s good to have surgeons there when you need them!” Of course it is. And they’re there. And competent midwives are well trained to detect problems, and women who aren’t anaesthetised and/or terrified can also detect when their body isn’t working as it should. And the ambulances and surgeons are there.
    Midwifery services aim to provide a safe, supportive birthing environment, and to intervene appropriately and only when necessary. Not to lock women in a basement and say “You’re on your own now, honey! HahahahahAHAHAHAH!”
    Lauredhel’s last blog post..Reducing major surgery by 80%: why are surgeons not interested?

  5. It’s strange the way we approach obstetrics. We don’t say ‘it’s great to have heart surgery, there’s no point in that healthy diet and exercise business’. Obviously it’s great to have surgery in an emergency, when it’s the only option, but that doesn’t mean it should be the first port of call.
    My friend who had twins last year never did get a good answer when she asked why, given that all her tests were showing that she and her babies were all perfectly healthy, the medical and midwifery team felt the need to stress over and over again how ‘high risk’ her pregnancy was. It made her incredibly stressed. She’s quite sure it contributed to needing intervention.

  6. I was an “elderly primogravida” when I had my now 7 year-old daughter and I remember being appalled at the assumptions made about my ability to give birth without substantial intervention given my age, weight (90kgs at 8 months pregnant)and the fact that I had a chronic disease (albeit in remission). The fact that I had lost weight during my pregnancy due to good diet and exercise and my health had been the best it had been for years didn’t enter into the equation – I was old and fat and that meant I was going to be trouble. It didn’t help matters when my waters broke at 36 weeks – too early, they said – even though the labour was quite obvioulsy progressingly swimmingly. I was keeping mobile and upright and the pain was managable with back massages applied by my birth partner, but no, they decided in their wisdom that I needed to be in bed, lying down and strapped to a foetal monitor, even though there was absolutely no sign the baby was in any difficulty. When I protested about that I was reminded that the baby was 4 weeks early and, I WAS an elderly primogravida, who was obese…blah, blah, blah. What happened was that my nicely progressing labour stopped dead in its tracks and I then had to have intervention some nine hours later because the labour was now taking too long…
    I still believe if I had been left to my own devices I would have had a healthy baby delivered after about 5 hours of labour, rather than a stressed baby delivered after 13 hours. Oh, and don’t get me started on the hatchet job the doctor did on the episiotomy and resultant suturing…
    I swear that if men had babies then everything, from (pre)conception to ante-natal care would be dealt with entirely differently.

  7. I went through the Birth Centre in Canberra last year and it was amazing. I had one midwife who took care of me for my whole pregnancy (with home visits) and throughout my labour and I felt empowered and supported the whole time.
    Unfortunately I did have to transfer upstairs into the hospital for Lily’s delivery (because she was posterior and got stuck), but my midwife came with me and I didn’t feel disempowered by the process. I also avoided having a C-section or an episiotomy with her support (both of which were offered to me). I also got to spend most of my very long labour at home (with my midwife) and in the bath at the Birth Centre. Spending it in a hospital room would have been horrible.
    Cristy’s last blog post..Sorry

  8. Every woman I know who has used a midwife-centred Birthing Centre has been very happy with their experience, no matter how little or how much further medical intervention ended up occurring.

  9. Lynda, I’m so sorry they did those things to you. It can be astounding the way that things the medical profession sees as “minor” and “routine”, not even “interventions” – like negative labelling, monitoring and confinement – can profoundly change your body’s response to labour.

%d bloggers like this: