Up to 60 per cent of planned caesarean sections are being performed before “full term” without a medical reason despite mounting evidence of the risks, from respiratory problems to poorer school performance, a new report shows.
For a long time, doctors considered 37 to 41 weeks of gestation “full term” but new evidence has prompted the definition to be tightened to between 39 and 41 weeks.
The report, to be released by Federal Health Minister Greg Hunt on Tuesday, found up to 60 per cent of planned caesarean sections are occurring before 39 weeks and up to 22 per cent before 37 weeks for no good reason and against guidelines.
“Emerging evidence links early births to an increased risk of long-term developmental problems such as poorer school performance and attention deficit hyperactivity disorder,” Jonathan Morris, Professor of Obstetrics and Gynaecology, said.
“We need more reliable and accurate data across the whole country about this.”
The rates are higher in the private sector, with 52 per cent of planned caesarean sections in public patients occurring before 39 weeks’ gestation without a medical reason compared to 60 per cent in privately funded patients.
A similar pattern was seen among patients giving birth before 37 weeks.
The report, produced by Australian Commission on Safety and Quality in Health Care, urges doctors to obtain fully informed patient consent by discussing the risks and the Medicare Benefits Schedule Review Taskforce to ensure item descriptors align with the latest clinical evidence.
The report also warns about the overuse of antibiotics in children including many cases where their use is not needed. For example, antibiotics are ineffective in children with most upper respiratory tract infections because they are caused by viruses.
“As a doctor I am always concerned when it seems that there is underuse of important investigations or treatments by people who could benefit greatly from their use,” Anne Duggan, the commission’s clinical director, said.
“For Aboriginal and Torres Strait Islander peoples, and people in regional and rural Australia, this is unfortunately true.”
Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Vijay Roach said the report was a “guide not gospel” and a “cultural change” was required to see more planned c-sections occur at approximately 39 weeks’ gestation.
