‘Every week counts’: High rates of early, planned caesarean births putting babies at risk

Doctors are concerned by the number of planned, non-medically necessary early births.

Doctors are concerned by the number of planned, non-medically necessary early births. Photo: Getty

A trend towards planned early caesarean births is putting babies at risk of respiratory issues and even behavioural issues, doctors have warned.

More and more women are opting – without medical reason – for caesareans before 39 weeks’ gestation, posing undue risk for babies’ health, a major new report states.

About half (between 43 per cent and 56 per cent) of planned C-section births performed before this key period in 2017 did not have a medical or obstetric reason, the Fourth Australian Atlas of Healthcare Variation released on Wednesday revealed.

Of particular concern were the 13 per cent to 19 per cent of all planned caesarean sections performed before 37 weeks that were not justified by a recorded medical or obstetric reason.

This is despite clear scientific evidence showing that waiting until at least the 39-week mark is best for the baby if there are no medical reasons for an earlier birth.

The figures “highlight the need for a concerted effort to address this issue,” said the report, which was produced by the Australian Commission on Safety and Quality in Health Care in partnership with the Australian Institute of Health and Welfare.

The commission’s acting chief medical officer, Conjoint Professor Anne Duggan, said the findings were concerning.

“If you’re born early, your brain, your lungs are not mature. You’re more likely to end up in intensive care for babies,” Dr Duggan said.

She said the apparent trend could mean many parents aren’t aware of the importance of a child reaching that important milestone.

“Most babies need those 39 weeks,” she said.

As a solution, the fourth Atlas recommended universal changes to government, hospital and insurer policies to stop the booking of planned births before 39 weeks without a medical or obstetric indication.

Waiting is best for baby

Australia’s high rates of early, planned caesarean sections without a documented medical reason point to a departure from evidence-based care, the report warned.

“While at times early birth is necessary, all too often it occurs without a medical or obstetric reason,” explained John Newnham AM, a professor in Obstetrics & Gynaecology at The University of Western Australia.

“The evidence is clear that waiting until at least 39 weeks is best for the baby’s development, unless there is a medical reason for an earlier birth.”

Early birth is associated with higher risks of adverse effects for the baby, with consequences ranging from respiratory problems at birth to long-term behavioural problems, Professor Newnham said.

“Every week counts towards the end of pregnancy,” he said.

Professor Newnham encouraged parents “to ask questions before booking an early caesarean section, to make sure their birth plans are best for both mother and baby”.

Operating theatre capacity questioned

Booked-out operating theatres could be contributing to the high volume of unnecessarily early caesareans.

“In some cases, a lack of capacity in theatre lists allocated for planned caesarean section once a woman has reached 39 weeks gestation may lead to theatre bookings at an earlier gestation,” the report said.

Hospital policies that offer increased flexibility to access operating theatres could help stem rates of planned early caesareans.

There are also major “gaps in women’s knowledge about the optimal timing of birth”, the report said.

“Providing education to parents about difference in outcomes, particularly effects on long-term child development, between early-term and full-term births could be a powerful strategy to reduce early planned birth where there are no medical or obstetric indications.”

More than half of the pregnant women surveyed in a 2015 study published in the Australian and New Zealand Journal of Obstetrics and Gynaecology wrongly believed that between 37 and 38 weeks gestation was the earliest time for safe birth.

Stillbirth prevention comes at a cost

Initiatives to prevent stillbirths may also be contributing to “increasing intervention in normal pregnancies”, the report said.

“Initiatives that reduce the risk of stillbirth can come at the cost of increasing intervention in normal pregnancies, due to the lack of specificity of techniques for identifying fetuses at greatest risk. This can result in increases in early planned births,” the report said.

The “risk of unintended consequences” of stillbirth reduction efforts was highlighted in a large UK trial, the report said.

Data from 409,175 pregnancies “showed significant increases in rates of caesarean section and inductions, without any reduction in rates of stillbirth”.

The report also cited the ‘Safer Baby Bundle’ initiative rolled out in New South Wales, Queensland and Victoria, which aims to reduce the risk of stillbirth.

The program “includes messages about the need to consider the adverse consequences of planned birth before 39 weeks”, but they “may be overshadowed by the influence of measures to avoid stillbirth”, the report said.

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