Wednesday 22 October 2014

Health-cover mums have far higher C-section rate

Eilish O'Regan Health Correspondent

Published 13/11/2012 | 05:00

THE rate of caesarean section for mothers with private health insurance continues to be far higher than among those who rely on public care.

An ESRI report reveals today that the rate of caesarean section among private patients climbed to more than one in three – 36pc – of births last year and 62pc were planned.

And rates of caesarean section also rose to more than one in four births – 27pc – for women who were public patients, with 46pc of these planned.

The Health Service Executive (HSE) set a caesarean target of no more than 20pc among the 71,231 mothers who gave birth in state-funded hospitals.

Although it is a common procedure, a caesarean section is still major abdominal surgery and, like any operation, it carries a certain amount of risk so hospitals are under pressure to reduce the rate.

Complications can include blood clots, infection, injury to the bladder, uterus or bowel, excessive bleeding and longer recovery time.

The higher rates among private patients led to the term "too posh to push" and also led to claims that busy doctors who must be present at the birth "time manage" by doing more caesarean sections while also adopting a cautious approach for fear of being sued.

Prof Michael Turner of the Coombe maternity hospital in Dublin said: "These findings are not surprising and are well described in high-income countries worldwide.

"The rates have risen in all the OECD countries over the last decade and, where information is collected, it is higher in private patients than public patients."

He added: "I would caution against a simplistic analysis because scientifically there is no single easy explanation for the rising rate worldwide.

"There are many influences on rates, such as the mother's age, obesity, improved antenatal diagnosis of fetal problems, advances in maternal safety, a woman's previous obstetric history, a previous caesarean section and increased rates of gestational diabetes."

He said he had just begun a major research study looking at the driving forces behind increased rates in Ireland over the last 15 years. The figures are contained in the report 'Activity in Acute Public Hospitals in Ireland', which gives a snapshot of how 57 hospitals are operating. It found that 83pc of those treated in public hospitals last year were public. Hospitals can admit 20pc of patients who are fee-paying.

Impact

Traditionally, the 80pc quota for public patients was not reached but a fall in the numbers covered by private health insurance is believed to be having an impact.

Prof Miriam Wiley of the ESRI, who compiled the report, said the evidence was that public hospitals were treating more patients, despite cuts in funding and in staff. There were more than 1.47 million discharges last year compared with 1.45 million in 2010.

Patients who were treated on a day basis, without the need for an overnight stay, went up to 60pc compared with 55pc in 2007.

The growing use of hospitals by older patients is also shown, as almost one-third of total discharges were aged 65 years and older, an increase of 1.5pc from 2010.

Patients are also spending less time in hospital – the average length of stay was 4.3 days in 2011. It was as low as four days in the south but rose to 4.6 in large hospitals in north Dublin and in the north east.

So called bed-blockers who were in hospital for more than a month accounted for 3pc of discharges and 29pc of in-patient bed days.

Irish Independent

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