Pregnant women choosing private hospitals for C-sections
High C-section rates prominent also in public hospital with 31.5% of deliveries
Matthew Vella
Malta’s rate of Caesarean sections, one of Europe’s highest, appears to be firmly rooted across both public and private spheres of healthcare, as statistics released by MaltaToday for the first time show.
Last year, over 43% of deliveries performed inside three private hospitals – namely the St James (Sliema and Zabbar) and St Philip’s hospitals – were by C-section, compared to 31.5% at Mater Dei, the state hospital.
Both rates are considered way above the 10-15% rate recommended by the World Health Organisation.
However, private hospitals had far lower numbers of mothers giving birth last year, with 186 deliveries taking place in St James’s two hospitals in Zabbar and Sliema; and 62 deliveries in St Philip’s.
C-sections in St James for 2007 comprised 35.4% of deliveries; and 66.1% in St Philip’s.
Mater Dei on the other hand performed 3,605 deliveries, of which 1,136 or 31.5% were by C-section.
These statistics are being published for the first time, after MaltaToday secured the consent of both St Philip’s and St James Hospitals to issue data concerning their rates of deliveries and C-sections. Previously, only aggregate data of all hospitals was issued by the Health Information Unit, until MaltaToday questioned this practice.
Choosing private
While private hospitals retain a high rate of almost one in every two women going for C-section, it is also true that fewer mothers are using private hospitals for childbearing, and that they specifically choose private hospitals for a planned (or elective) Caesarean delivery because they demand it in the first place.
For example, last year St Philip’s Hospital performed only 62 deliveries, compared to the 167 it performed in 2000, of which 40% were by C-section.
Similarly for St James, it performed 257 deliveries in 2000, of which 26% were by C-section. Last year it performed 187, of which 35.4% were by C-section.
One explanation offered by Dr Frank Portelli, the director of St Philip’s, was that a greater proportion of women choosing private hospitals are prone to demand a C-section.
His explanation is confirmed by veteran gynaecologist Donald Felice, who also said that a “select population” makes use of private hospitals, and who might be more inclined to demand Caesarean delivery. “Some mothers demand it, fearing damage to their vaginal muscles,” Felice had said.
He added that when mothers demand C-sections, doctors found it “difficult to resist this attitude” because of fears of litigation.
The propensity for performing C-sections inside private hospitals is confirmed by the statistics for the last eight years.
Between 2000 and 2008, an average of 47.6% of deliveries at St James’s Hospital in Sliema were performed by C-section, while St Philip’s performed C-sections in 49.5% of deliveries during the same eight-year period.
Alarm bells
Such data however does not lift the focus off the state hospital, which retains a 26.5% average over the same eight-year period.
Last year alone, it performed C-sections in 31.5% of its 3,605 deliveries.
Criticism of the high level of C-sections often comes from midwives. Maria Cutajar, the vice-president of the Malta Union of Nurses and Midwives, says Malta’s rate of C-sections could be due to the high rate of induced pregnancies.
“I don’t know why we don’t have an audit by the health department on obstetrics. I would think that the alarm bells should be ringing by now,” she told this newspaper three weeks ago.
Induced pregnancy is in fact central to international worries on Caesarean deliveries. The European Perinatal Health Report published recently, found Malta had one of the highest rates of planned Caesareans and induced labour.
Such a statement raises the spectre of more doctors choosing to induce mothers’ labour for a scheduled, planned Caesarean, either because the mother would have demanded it, or for their personal or the hospital’s convenience.
It would mean a doctor can schedule a date for the delivery, come in at the morning to induce the mother’s labour by administering a drug, and deliver the baby by the afternoon – rather than waiting for the labour to take its course naturally, which could take hours on end.
And as the data shows, in the private sector, elective or planned C-sections comprised 50% of C-sections, while at Mater Dei these were 52%.
In contrast, a Caesarean done during labour by necessity is termed an emergency Caesarean section.
Global scenario
Doctors will be quick to point out that all planned C-sections are carried out according to clinical guidelines, and that in certain cases these are necessary.
Midwives on the other hand list a host of reasons why private hospitals are more prone to deliver by C-section, such as the payout of insurance money on Caesareans, which involves major abdominal surgery.
The situation is similar in the UK, where 24% of deliveries were by C-section in 2007, half of which were planned or elective.
Even in the US, C-sections have been breaching the WHO threshold every year since 1996. There, hospitals fear that they will be sued, and instead of using methods such as allowing a woman to walk – in order to encourage a breech baby to turn – or waiting for labour to progress, obstetricians jump straight to Caesareans.
The Royal College of Midwives points out that society’s tolerance for pain has become “significantly reduced” and that women have lost their confidence in their ability to give birth, which is why they are scared of pain.
Any comments?
If you wish your comments to be published in our Letters pages please click button below. Please write a contact number and a postal address where you may be contacted.
Download front page in pdf file format
All the interviews from Reporter on MaltaToday's YouTube channel.
Wanted:
an independent voice News that GRTU director general Vince Farrugia has been approached to contest the MEP elections on behalf of the Nationalist Party will certainly raise eyebrows among those who have closely followed the industry lobbyist’s lengthy career...>>
