Dear Listers, The exchange continues in the Canberra Times. The following letter was published on Wed 30 Jan as the banner letter. I'm grateful to the obstetricians in the letters (posted on the List by Tina last week) for giving me another opportunity to try and get women thinking about the choices they make....
regards Barb ---------- From: Vernon at Stringybark <[EMAIL PROTECTED]> Date: Fri, 25 Jan 2002 22:09:32 +1100 To: <[EMAIL PROTECTED]> Bcc: <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>, Justine Caines <[EMAIL PROTECTED]>, Emma Baldock <ebaldock@ozemail>, David Vernon <[EMAIL PROTECTED]> Subject: Reply to Stafford-Bell & Shroot Given the published personal attacks on me contained in Letters of 24 January, I hope you will give me a right of reply. Thank you. ---------------------------------------------------------------------- Dear sir, Drs Stafford-Bell and Shroot (Letters, CT January 24) reject the comparison I made (Letters CT January 17) between public and private hospital intervention rates in childbirth. They argue that private hospitals take on women who are at higher risk of complications, especially older women and those with particularly precious pregnancies¹ (surely all pregnancies are precious!). These comments fail to take into account recent research. In the British Medical Journal (vol.321, 15 July 2000) Roberts et. al compare rates of obstetric intervention between public and private patients in 171,000 livebirths in NSW in 1996-97. The study takes into account age and risk differences between public and private patients by identifying low risk women and adjusting for age. About half of all women choosing either private or public care were low risk. That is they had no medical or obstetric complication, and carried a single baby of normal size and head down presentation to term. Yet the private low risk patients were "significantly more likely to have interventions before birth" (epidural, induction or augmentation) as well as "increased interventions at birth" (especially forceps, vacuum extraction and episiotomy). The study also finds that of all first time mothers at low risk only 18% of private women achieved a vaginal birth without any intervention compared with 39% of public women. It concludes: "there are no obvious clinical reasons for intervention rates to be higher in private than in public patients". It also notes that "international comparisons show Australia to have among the highest rates for obstetric intervention". Given that the latest national report on maternal mortality shows a marked rise in preventable deaths related to childbirth, it is time to take action to reduce obstetric interventions. Certainly women need better education and support to make informed choices about their care. But doctors have a crucial role to play in lessening intervention rates. Dr Barbara Vernon National President Maternity Coalition PO Box 269 Lyneham ACT 2602 02 6230 2107 Letters to the Editor (24/1/02) Thursday, 24 January 2002 These women likely to need caesareans DR BARBARA VERNON of the Maternity Coalition (CT, Letters, January 17) disagrees in part with the sentiments of Dr Heather Munro upon her retirement. As you might expect I find myself totally in agreement with Dr Munro, as I imagine would most practising obstetricians. Dr Vernon lauds the Canberra Hospital and its alternative birthing programs and suggest that the caesarean rates are lower than in the private system. Since a large number of well educated women, particularly the older ones or those with particularly precious pregnancies who are more likely to require caesareans, tend to go to experienced private obstetricians for their confinement, Dr Vernon is committing (presumably deliberately) the first sin of statistics, namely, the presentation of data derived from the comparison of dissimilar groups. She also very neatly (and since I can't believe it's due to ignorance I presume it's deliberate) omits all reference to maternal and baby mortality and morbidity, morbidity being roughly defined as temporary or ongoing illness, disability or other symptoms as a result of confinement. If she wishes to appear objective and unbiased, I would suggest that not only should she compare similar groups to produce her figures, but that she should also compare mortality and short and long term morbidity in the public and private systems. She might be quite surprised at the results derived from this latter exercise. M. A. STAFFORD-BELL Deakin More seeking intervention AS A GP who practised obstetrics for over 25 years I take issue with the letter of Dr Barbara Vernon (CT, January 17). Taking the raw figures for caesarean sections from different hospitals and making sweeping statements is unscientific. The types of cases managed in different centres dictates the rate. Many women are choosing intervention. Some are primigravidas (first pregnancies) and have heard about the terrors of labour. Others have experienced a difficult labour and do not wish to do so again. In either case, a vaginal delivery would be desirable from the obstetric viewpoint but in this day of choice they insist on (and receive) a caesarean section. The statement that ''caesarean is riskier than vaginal birth for both mother and baby'' is, overall, certainly the case. However, if a patient has complications, then caesarean section has far less risk for both mother and baby than continuing labour. Obstetricians do not intervene for other than good, sound, medical reasons (with the exception stated above). The maternal deaths, neonatal deaths and morbidity statistics in Australia and overseas also require examination before accepting any of Dr Vernon's assertions in these areas. Obstetrics is a high-stress area of medicine. Those who devote their life to the specialty deserve more support than Barbara Vernon's diatribe. Dr ALAN D. SHROOT Aranda -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
