Guidelines aim to reduce caesareans

New guidelines on birth procedure will help to reduce the number of caesareans by giving clinicians more confidence to continue with normal births, says the group developing the guide.

A Health Ministry maternity services report published last week says 22 per cent of hospital births in 2001 were by caesarean section, and the rate grew 1 per cent annually over the last four years.

But a working party established by the National Guidelines Group is developing guidelines for safe and effective alternatives to caesarean births.

Convener Professor Cindy Farquhar, of National Women's Hospital in Auckland, said the guidelines represented best practice, and clinicians who adopted them would have greater protection if things went wrong, leading to disciplinary or other proceedings.

Professor Farquhar said the guidelines were being developed with the help of the latest international research.

They were expected to be finalised in June.

Palmerston North woman Philippa Peck, who has had four caesareans, said women were often not told there were alternatives.

"A caesarean is major abdominal surgery. Women should not have to go through that when it is not necessary," she said.

"There is a certain amount of anxiety about having your stomach cut open when you are awake."

Ms Peck, who is a representative on the guidelines group, said some health providers had policies that if a woman who had already had two caesareans became pregnant, the third birth would automatically be a caesarean, even if a vaginal birth was feasible.

"Women are having surgery they do not need. This is an informed consent issue."

Professor Farquhar said most women who had had two caesareans still had a reasonably good chance of delivering vaginally.

Ms Peck said women often suffered bad side-effects after caesareans.

"I haemorrhaged after one and lost lots of blood. I found it difficult to breast-feed because my children pressed down on my wounds.

"I have ongoing pain as a result of nerve regeneration.

"I have a numb patch on my stomach that will eventually need surgery."

After each caesarean she was told not to drive for six weeks, and to lift nothing heavier than her baby.

But Ms Peck said her caesareans were medically necessary because she was small and had big babies.

College of Midwives spokeswoman Alison Eddy said the World Health Organisation recommended that 80 to 85 per cent of women should be able to give birth naturally.

She hoped the guidelines would mean more births could be achieved without surgical intervention.

Ms Eddy said there was a common perception that caesareans were a safer option for potentially difficult births, but that was often not the case.

- NZPA