A doctor who was initially denied a caesarean section says all women should be able to choose the surgery.
The new mother works at Auckland City Hospital, and used a private obstetrician during her pregnancy.
Her husband also works in health, and together they decided to request an elective C-section, for reasons including the size of their baby, and to avoid the risk of certain complications for mother and child.
“It was about wanting to have a really safe delivery and to ensure that our baby arrived safely as well,” said the woman, who asked not to be named, and whose area of work is not women’s health.
“As medical students and through our work, we’ve seen really bad complications that often go untreated. Incontinence, prolapse, all sorts of things – it’s language that isn’t used day-to-day, because women’s health is still very much a taboo subject.”
A week after she took maternity leave, New Zealand went into level 4 lockdown. Elective surgeries, including hers, were cancelled as hospitals freed-up capacity for an expected influx of Covid-19 cases.
A caesarean may be planned (elective) or unplanned (emergency), if complications develop and delivery needs to be quick.
Auckland DHB wants to rein in elective numbers, and has blocked more private obstetricians from using its facilities, because their patients are more likely to have a planned caesarean, and often live outside the DHB boundaries.
The 26 private specialists with existing access have had their requests put under more scrutiny, particularly when Covid-19 threatened.
The woman’s private obstetrician suggested she might pay to see a psychiatrist, who, after a Zoom consultation, wrote a report supporting her request.
Ultimately it wasn’t submitted; she wrote to the head of service, who suggested she see a psychiatrist through the public system. After learning she’d done so privately, the hospital finally booked the c-section.
The April 14 surgery went well, and she was discharged to Birthcare the next day, and went home the following day.
“We feel so lucky that we were able to birth [the daughter] safely but we recognise that this isn’t the case for all parents. It is a huge inequity that elective C-section for maternal choice can only be performed for people who are fortunate enough to be able to afford private obstetric care,” said the woman.
“Instead of reducing services offered in maternity, the public system needs to better inform people of the risks and expectations of the different methods of birthing and recognise that they should have autonomy over their bodies, including the way they choose to birth.”
There is a lack of private birthing facilities, and for decades women looked after by private obstetricians (at a cost of about $6000) have used Auckland DHB labour and birthing facilities.
Recent DHB board meeting minutes noted, “women do not have the right to determine whether they can have a C-section or induction; this should be decided on the basis only of clinical need”.
“The DHB has limited resources and Auckland DHB provides the majority of services to people who cannot afford a private obstetrician. That means when the private obstetrician comes in and uses theatre capacity that theatre becomes unavailable to the rest of the Auckland population.”
The board was given statistics showing about half the patients cared for by private obstetricians are NZ European, compared to 2 per cent Māori and 2 per cent Pacific. The rest are mostly Asian, “other European” and Indian.
Auckland DHB chief executive Ailsa Claire has previously said the situation where women saw psychiatrists to get C-sections “occurred during a time of heightened risk of a surge of Covid-19”.
“In some instances where case reviews showed no clear clinical evidence, patients cared for by private obstetricians were able to provide psychological assessments that supported the clinical need for caesarean sections. Once this clinical need was established, these C-sections went ahead.”
The College of Midwives supports efforts to ensure there are medical reasons for C-sections, saying babies not exposed to any labour are more likely to experience breathing difficulties after birth, and that C-sections have implications for longer-term health, future pregnancies, and are resource-intensive.
Guidelines in other countries, including the UK, allow for maternal request caesareans, but the NZ Ministry of Health’s position is that “no public funding is to be made available for non-clinically indicated elective caesarean sections”.
That should change, the doctor said.
“Why is it that the Ministry of Health can control how we birth? All women should have a choice to birth however they want to.”
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