Costs warning as caesarean rate continues to rise

By MARTIN JOHNSTON health reporter

The caesarean rate is continuing its rapid rise at New Zealand's leading women's hospital and doctors are warning of a blow-out in costs.

At National Women's Hospital last year, 26.6 per cent of the 7827 births were caesareans, says the hospital's annual clinical report.

In 1999, it was 24.5 per cent. The rate has risen virtually every year in the past decade, from 16.6 per cent in 1991, and is one of the highest of New Zealand maternity units.

Fewer than half of women now have their first baby by a normal vaginal delivery at the hospital.

"This has implications for the women and the services that need to be provided," says the report.

These include infections and surgical complications after caesareans. Doctors say caesareans are much more costly because many more doctors and nurses are needed.

The College of Midwives says women who have caesareans without good medical reasons should have to pay the $6000 cost.

The National Women's report says: "There is a belief that maternal request is an increasingly important factor in the decision to perform caesarean section." Patient request was listed as a factor in 2.5 per cent of caesareans.

Dr Angela Mills, a British obstetrician-gynaecologist invited to comment on the report, said there was no good data comparing the risks of vaginal and caesarean births.

"I'm prejudiced in favour of going for vaginal delivery," said Dr Mills, of the University College Hospitals, London.

The World Health Organisation has suggested that the global caesarean rate should be no higher than 15 per cent of births, but Dr Mills said that it was far higher in some countries, such as Brazil's 60 to 80 per cent.

She said Britain's rate had been pushed up by pop stars having caesareans. Obstetricians' thresholds for approving caesareans might be declining in response to the rising risk of legal action against them after attempted vaginal births went wrong.

New Zealand's Health Ministry is having guidelines written on the performing of caesarean sections.



Flag1: OIL


Head1: Petrol prices yo-yo at the pumps


Blurb1: An unpredictable world oil market means motorists face fluctuating petrol prices.


Byline1: By PAULA OLIVER

Body1:

Volatile petrol prices look likely to give motorists a bumpy ride in coming weeks, as oil companies wrestle with uncertainty in the Middle East.

The warnings of rapid price changes came after the big four yesterday shaved 6c off the price of a litre of petrol and 2c off diesel.

Motorists were told to brace themselves for a series of petrol price rises and falls in the short term.

The volatility stems from the unpredictable world oil market and a New Zealand dollar that has continued to lose value.

Yesterday's petrol price cut was a swift response to Monday's dramatic 13 per cent fall in world oil prices - the biggest price collapse in a single day since the Gulf War in 1991.

It was also a sign of what is in store for motorists; coming less than a week after petrol prices surged upward by 9c a litre.

The price of a litre of diesel now sits at 78.9c, regular petrol 106.9c and premium petrol 111.9c at main-centre Shell and BP stations.

International analysts say that the tumble in world crude prices was caused by growing confidence that the US-led war against terrorism would not severely disrupt oil supplies.

There had been widespread fears of an oil shortage, but this was partly quelled by repeated assurances from the Organisation of Petroleum Exporting Countries (Opec) that it would maintain steady supplies and partly offset by a global economic downturn that has reduced demand for oil.

Shell led yesterday's petrol price cuts. It was quickly matched by BP, Mobil and Caltex.

Shell NZ's retail manager Steve Foster said the company would review prices daily.

BP warned that it was very difficult to predict what would happen next. But it was possible that even the rising cost of shipping could affect petrol prices if the New Zealand dollar continued to fall.

World oil prices are now at their lowest in 17 months, and refined petrol out of Singapore - from where most New Zealand petrol is imported - has fallen heavily in the past week.

Opec's leaders, who have enjoyed the fruits of a two-year oil price boom, are to meet in Vienna today to discuss the price slump.

Some international analysts are predicting that world oil prices will fall further by Christmas.

One said it was a blessing for the world economy.