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Kurt Sansone
The number of caesarean births in the first six months of this year accounted for 30.3 per cent of all deliveries, a rate double that recommended by the World Health Organisation (WHO).
But despite this alarmingly high rate of caesarean deliveries the health authorities are not perturbed by the situation. According to a doctor at the Department of Health Information, the rates are “comparable to rates in other European countries.”
Even so, midwives who spoke to this newspaper expressed their regret at the situation, which sees an increasing number of women going under the knife rather than giving birth as nature intended.
According to statistics made available to MaltaToday by the Department of Health Information, the rate of deliveries throughout Malta and Gozo by caesarean section in 2003 was 26.9 per cent. This represented an increase of 2.6 per cent over the figure for 2002 (24.3 per cent). In 2001 c-sections accounted for 24.2 per cent of all births.
Judging from the half-yearly statistics for 2004, the annual rate is expected to register a further increase.
The health authorities would not give a breakdown of statistics for the individual hospitals both private and public.
Speeding up labour
Experts believe the rise in c-sections is due to doctors recommending the operation to ‘speed up’ labour and the belief by some women that opting for caesarean was the ‘easier’ way of having a baby.
However, Dr Miriam Gatt for the Department of Health Information insisted c-section is only advised when clinically indicated.
“To our knowledge, mothers are not enticed into delivering by caesarean section,” she said when asked whether expectant mothers were being talked into having a caesarean by some doctors.
“Caesarean section rates are comparable to rates in other European countries. They are similar when compared to Western practices. WHO suggested rates are to be interpreted with caution as they may not be realistic in Western practice,” Dr Gatt said.
The spokesperson insisted c-section rates should not be interpreted on their own since Malta had a perinatal mortality rate lower than the European average. “Rarely do we encounter a maternal death,” the spokesperson said.
Contacted by this newspaper, the WHO Regional Office Europe insisted its recommendations were applicable to all countries.
Liuba Negru, a spokesperson for the international organisation’s European regional office quoted from a document compiled by a technical working group assembled by WHO in 1994: “In setting acceptable limits for caesarean section it seems appropriate to have both a minimum and a maximum. Five per cent of all births in the population is a relatively conservative lower limit; for the upper limit 15 per cent seems reasonable. It is slightly higher than the level in those countries known to have problems with excessive use of this procedure. These minimum and maximum levels have been adopted for global use by the Technical Working Group assembled by WHO.”
The WHO spokesperson reiterated that c-section is a surgical intervention that carries all the risks of an operation. “Caesarean section is a surgical intervention and as such should be guided by correct indication and appropriate surgical and pre and post surgical procedures,” Negru said.
Britain halts rise
Indeed, many European countries have caesarean rates much higher than WHO’s recommended upper limit. Statistics for Britain show that in 2003 the rate of c-sections stood at 22 per cent, which is still 4.9 per cent lower than the rate in Malta.
Last year was the first time in more than 20 years that Britain did not experience an increase in c-section delivery rates. The news was greeted positively by the National Childbirth Trust that had been campaigning to raise awareness of the public health consequences of caesareans.
On the other hand, The Royal College of Midwives expressed disappointment that the caesarean rate had not actually fallen.
High c-section rates in Britain are cause for concern and in April this year the National Institute for Clinical Excellence, government’s watchdog on the National Health Service, drafted guidelines advising doctors there must be a “medical reason for women to be given a caesarean on the NHS.”
A totally different story is to be found in the Scandinavian countries including The Netherlands where national c-section rates are within the parameters established by WHO and have been so for a number of years. These countries have just as good a safety record on the health of mother and baby as Britain and Malta.
kurt@newsworksltd.com
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