High numbers of caesarean births are being scheduled for a week or two before a baby’s due date, worrying gynaecologists and obstetricians who say the practice puts newborns at unnecessary risk of short- and long-term health impacts.
Roughly half of caesarean section births performed before 39 weeks were booked without a medical justification in 2017, according to a national report.
Babies born at scheduled early caesareans are being placed at unnecessary risk, warn experts.Credit:Nic Walker
In NSW, such procedures made up 51.8 per cent of the 10,381 early caesarean sections performed during the year. Figures were lower in Victoria, where 44.3 per cent of 10,108 early caesareans had no recorded medical reason.
Rates of procedures without a medical reason resulting in early births were highest in South Australia (56.1 per cent of caesareans before 39 weeks), Western Australia (55.5 per cent) and Queensland (55 per cent).
The findings were published in the Fourth Australian Atlas of Healthcare Variation, produced by the Australian Commission on Safety and Quality in Healthcare and the Australian Institute of Health and Welfare, on Wednesday.
“There is clearly a trend to earlier birth, we are slipping in the wrong direction,” said Professor Anne Duggan, acting chief medical officer of the commission.
Professor John Newnham, former senior Australian of the year and chair of the Australia Pre-term Birth Prevention Alliance, said “relatively new” advice as to what is a full-term birth was likely partly to blame.
Births between 37 and 41 weeks gestation were previously categorised as “full-term”, but from 2010 the definition was changed and only applied to births between 39 and 40 weeks.
Babies born at 37 to 38 weeks gestation are now classed as “early-term”.
While early birth may be necessary for patients with certain conditions such as pre-eclampsia, Professor Newnham said growing evidence of the relationship between early birth and a child’s risk of ADHD and learning difficulties meant the profession needed to make messaging against the practice a priority.
“I think that the healthcare workforce and the women and families of Australia have not fully understood the seriousness of this,” he said.
Short-term risk of early birth, including respiratory problems and the need for neonatal intensive care, increase when a baby is delivered by caesarean or induction.
Risk of conditions such as hypoglycaemia and jaundice, as well as a need for neonatal intensive care, decrease between 37 and 41 weeks gestation for babies born by caesarean.
Dr Vijay Roach, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said early caesareans without a medical reason often occurred when a patient was experiencing other distress.
“A woman comes in and she’s miserable and uncomfortable, so the doctor sees she has a caesarean already booked for two weeks time and moves it forward,” he said.
Dr Roach said the college had been educating its members about risks of early caesarean birth and supported the findings.
“The message is very clear, we need to change our thinking from pregnancy ending at 37 weeks, which is how we were all educated,” he said.
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