Doctors try to restrain caesarean rate

Doctors Karen Buckingham with daughter Kate (left) and Kirstie Peake with daughter Sophie. Picture / Martin Sykes

Three National Women's Health specialists are leading by example in the bid to restrain New Zealand's rising rate of caesarean births.

The first babies of Auckland City Hospital obstetricians Karen Buckingham, Kirstie Peake and Anna Bashford were delivered by caesarean, but second time around the mothers bucked the trend and had vaginal births.

"It was mostly because I would feel a bit of a fraud otherwise," said Dr Buckingham. "As an obstetrician you are encouraging your patients to have vaginal delivery after a previous caesarean if there are no other complicating factors.

"If you are not prepared to have one yourself, it seems not very fair."

The three babies' deliveries came after new guidelines urged women who had caesareans to opt for a vaginal birth next time. The guidelines are one attempt to hold back New Zealand's rising caesarean rate.

By 2002, the rate had virtually doubled in 14 years, to almost a quarter of all births, partly as parents' birth-risk worries have grown and health workers have felt more vulnerable if things go wrong.

But caesarean delivery, a major operation, carries its own risks, such as wound infection and blood loss.

Having one caesarean greatly increases the chances of having another for subsequent births.

Cindy Farquhar, the head guideline writer and professor of obstetrics and gynaecology at National Women's, said when she did her specialist training in the 1980s, about half of the women who had a previous caesarean went on to have a vaginal birth. That had now dropped to a quarter.

"It's an old concept. It's got a little lost in our anxiety about childbirth and the risks associated with it."

There was a small risk of the uterus rupturing during an attempted vaginal birth following a previous caesarean.

The risks of harm to the baby were no higher than if it was a woman's first birth and it was a vaginal delivery.

Dr Buckingham's babies were born at National Women's. She had a pre-arranged caesarean for her first, Jack Pearson, now aged 2, because he was lying breech in the uterus - bottom first rather than head first.

After giving birth vaginally last December to her second baby, Kate Pearson, she consequently recovered more quickly, "a big bonus when you've got a toddler to look after".

"I would certainly have a vaginal delivery next time."

Caesarean rates

* 12 per cent of births nationally in 1988; 23 per cent in 2002.
* 17 per cent at National Women's Hospital (now Health) in 1992; about 30 per cent now.
* 50 per cent of mothers at National Women's who had had a previous caesarean subsequently gave birth vaginally during the 1980s; 25 per cent now.