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Too posh to push? Concerns over state's rising number of elective caesarean births

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Queensland private hospitals have the highest rate of planned but potentially unjustified early caesarean births in Australia.

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The Fourth Australian Atlas of Healthcare Variation, produced by the Australian Commission on Safety and Quality in Health Care in partnership with the Australian Institute of Health and Welfare, shines a spotlight on the extremes of medical services.

The atlas reveals around half of planned caesarean section births performed before 39 weeks did not have a medical or obstetric reason. More concerning was the fact there was no evidence to support up to 19 per cent of C-section births performed before 37 weeks.

In the private sector, Queensland has the highest rate of unjustified early caesareans in Australia – 60.8 per cent of all deliveries. Taking public sector births into account, Queensland was still in the top three states overall for that measure in the atlas.

Professor John Newnham AM from the University of Western Australia said births before 39 weeks were considered early, and, for the baby, raised the risk of respiratory problems or, over the longer term, behavioural and learning problems.

Yet in Australia, the proportion of babies born early is increasing, and the rate of caesarean births is higher than the average for countries in the Organisation for Economic Co-operation and Development.

“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,” Newnham said.

While there are likely multiple factors leading to high caesarean rates, the organisations behind the atlas have called for universal changes to government, hospital and insurer policies to stop booking of planned births before 39 weeks without a medical or obstetric reason for doing so.

“It is also important for parents to have accurate information about the risks and benefits of early planned birth, and access to clinicians and facilities at the right time,” said Newnham, the 2020 Senior Australian of the Year.

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

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