Saturday, 3 August 2013

Three women walk into a hospital.....

Three women walk into a hospital......


Irene Irishwoman, Polly Polish woman, and Lisa Lithuanian woman.

 Irene the Irishwoman says "I'm a first time mum I need to see a consultant"   

 Polly the Polish woman says 'I'm a healthy first time mum - why do I need to see a doctor?”

and Lisa the Lithuanian woman says “why am I in hospital?” 

Who ends up with the unnecessary caesarean section?   



AIMSI have just been sent some new research called:

"International variation in caesarean section rates and maternal obesity".
V. O’ Dwyer1 , R. Layte2 , C. O’ Connor1 , N. Farah1 , M. M. Kennelly1 & M. J. Turner 1

Study Purpose:

"This study examined variations in caesarean section (CS) rates associated with a woman ’ s birthplace and differences in maternal adiposity. Women were enrolled in the 1st trimester. Maternal adiposity was assessed by body mass index (BMI) and bioelectrical impedance analysis (BIA). Irish women were compared with women born in the 14 countries who joined the European Union (EU) before 2004 (EU 14), and with those born in 12 countries who joined following enlargement (EU 12)."

"Based on place of birth, the women in this study were grouped
into Irish women, those from all the other 14 European Union
(EU) member countries before EU enlargement in 2004 (Austria,
Belgium, Denmark, Finland, France, Germany, Greece, Italy, Luxembourg, Netherlands, Spain, Sweden, Portugal, UK) and those from the EU 12 countries that joined the EU aft er 2004 (Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia, Bulgaria and Romania)."


"We found that the emergency CS rate in primigravidas was increased in Irish women compared with the rate in women born in the countries admitted to the EU since 2004. The increase in CS rate was associated with increased maternal obesity in the women born in Ireland."

"There was no difference in the rate of pre-eclampsia between the three groups (Table I). There was a higher rate of gestational diabetes mellitus (GDM) among Irish and EU 14 women compared with EU 12 women (Table I). Of the women with GDM, nine had a normal BMI, 13 were overweight and 40 were obese. Labour and delivery details are shown in Table III.

There was a higher rate of induction of labour among the Irish compared with the EU 12 primigravidas (p 0.05).

The emergency CS rate was higher in Irish primigravidas compared with EU primigravidas (p 0.001).

The main indication for CS was fetal distress in labour (54.0%).

There was no difference in the CS rate between multigravidas from Ireland and multigravidas from other EU countries.

There was no difference in the mean gestation at delivery, mean birth weight or number of babies born weighing 4kg between the three groups.

There was no difference in the mean age between the three groups. Irish women were more likely to smoke than other EU women. However, the CS rate was not affected by smoking status."


 AIMSI Thoughts:

 AIMS Ireland fully accepts that maternal obesity is a growing concern in relation to perinatal and maternal health, however, previous studies may suggest other factors which could have affected outcome.

 * First time Irish mothers are more likely to have private health insurance and attend a private obstetrician compared to non-nationals. As we have seen from several studies, attending a private obstetrician increases the risk of Caesarean Section significantly, this Irish Times article suggests as much as 74%

Caesarean rate higher in private care

* Non-Nationals are less likely to use epidural in labour. The epidural means that your labour is considered 'high risk' and will require different management to 'low risk' labours. This includes the use of continuous monitoring (CTG) which is shown to have high rates of false positives, increasing a women's risk of intervention and caesarean section.

"Three quarters of non-national women have a normal vaginal birth rather than a caesarean section or vacuum birth. This is far higher than the rate for Irish women of 65%. A fifth of non-nationals (23%) had induced labour, a third lower than the Irish rate of 31%. "

29% of non-nationals used epidural compared with 42% of Irish women.

Non-nationals opt for natural births

* This study was done in the Coombe, which follows an induction policy of term+ 10 days. Private Patients often have a shorter post dates period.

If you look at the results for this study Irish while Irish first time mothers had higher Caesarean rates than their EU counterparts. Interestingly, the results between Irish and Non-national women appear to be the same if they have given birth before. AIMSI feels this illustrates the point that the cultural beliefs of Irish women put them at a greater risk of Caesarean Section by going private as first time mothers.

It would be interesting to see the results of a similar study with public patients within a unit of term+14 days induction policy.




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