Baby mortality rates spark call for inquiry

By MONIQUE DEVEREUX

The Ministry of Health wants some district health boards to investigate why the death rate of babies born in their hospitals is relatively high.

The call comes after a major report on maternity in New Zealand revealed differences in baby mortality rates in various health districts.

The report's authors recommended further investigation in the area of perinatal deaths - babies who were either stillborn or who died soon after birth.

Some 585 babies fitted those categories in 1999 - the year covered by the report - out of 52,273 births.

The highest rate of perinatal deaths was in Hawkes Bay, where 16 babies per 1000 born (1.6 per cent) were stillborn or died within a week.

The national average was 11 peri-natal deaths per 1000 babies born - 1.1 per cent - which the report said was a "creditable rate by international standards".

In 1999 there were 2133 births in Hawkes Bay, including 34 perinatal deaths.

In the Tairawhiti region, covering Gisborne and the East Cape, 1.5 per cent of babies died. There were 722 births in 1999 and 11 perinatal deaths. On the West Coast 1.3 per cent of babies were stillborn or died within a week.

The region had 369 births in 1999, including five perinatal deaths.

In comparison, Counties Manukau - which handled the most births of any district health board in 1999 - had a death rate of 1.1 per cent, equating to 79 perinatal deaths from 7092 births.

"These data show important differences in outcomes between DHBs," the report said.

"It is hoped that individual DHBs will investigate these discrepancies."

The report also noted that of the individual hospitals, Wellington, Whangarei and Hastings had the highest rate of stillbirths.

"These stillbirths data require further exploration."

Last night, Tairawhiti chief executive Jim Green said that in a small health board with low birth rates, one or two deaths obviously made a huge difference to the overall rate.

"So you have got to be wary of that when you are dealing in small figures, but yes, we will be investigating."

The Ministry of Health report is the first of its kind into all aspects of maternity. The information was collected from a variety of practitioners and matched against hospital records.

The report covered a range of statistics, from birth weights and number of previous births and pregnancies, to the use of epidurals.

The information was broken down by age, race, region and particular hospital.

The maternity report also noted that on a national basis the perinatal death rate had fallen over recent years.

Babies born to Asian women had a particularly low rate of stillbirths and a complete absence of recorded deaths in the first month after birth.

The report also highlighted an increase in births to Asian and Pacific women, although Maori and Pacific women have more children, starting at a younger age.

Almost 60 per cent of births were to women aged between 25 and 34 and 7 per cent were to teenagers.

The report confirms an increase in caesareans - now at 20.4 per cent - which concerns medical experts because of the extra risk involved.

The highest rate of elective caesarean was at St George's maternity hospital in Christchurch, where they accounted for 45 per cent of births. Middlemore Hospital in South Auckland recorded 4 per cent.

The report found that five of the country's six tertiary maternity facilities - National Women's, Waikato, Wellington, Christchurch Women's and Dunedin - had "significantly higher" caesarean rates than the national average, with only Middlemore the exception.

The ministry plans to complete maternity reports annually from now on.

nzherald.co.nz/health