Doctors Told To Stop Delivering Caesarean Babies Before Full Term

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.

The Third Australian Atlas of Healthcare Variation has found wide disparities in the provision of treatments such as antibiotics in children, colonoscopy and gastroscopy across the country and also places the spotlight on caesarean section births.



"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.




Professor Anne Duggan.

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.

The Atlas attempts to map healthcare, identify variations and reduce inappropriate use.

It has found the hospitalisation rate for inpatient colonoscopy is 7.4 times higher in Hawkesbury, NSW, which has the highest rate, compared to the area with the lowest, Woden Valley in the ACT, suggesting some people may be exposed to unnecessary risk.

Colonoscopies are usually performed to detect bowel cancer but it found "substantial overuse" in some areas and "underuse" in others, signifying a "poor use of resources".

In regards to gastroscopy, usually used to investigate upper gastrointestinal symptoms such as heartburn, people living in the northern part of the eastern suburbs in NSW are 7.4 times more likely to undergo the treatment than those in Weston Creek in the ACT.

"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."

The Atlas found a clear anomaly between cancer burden and use of investigations for gastrointestinal diseases in Australia.

The national rate for colonoscopy hospitalisations is about 1.5 times that for gastroscopy hospitalisations, yet the incidence of colorectal cancer is about seven times that of stomach cancer and about 11 times that of oesophageal cancer.

"Both these procedures are often performed by the same doctor, so gastroscopies that are of limited benefit should be minimised, and that theatre time allocated to people with a greater need for a timely colonoscopy, who might otherwise miss out on a potentially life-saving cancer diagnosis," Professor Duggan said.

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.

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