Federal Politics


Intervention rates warrant scrutiny

Debate about the necessity of medical treatment and surgical intervention is common to all branches of medicine, but is particularly dissentious in obstetrics. Although most women should not require surgical intervention when giving birth, study after study indicates the rate of babies being delivered by caesarean section is rising, especially among well-to-do women able to access first-class obstetrical care. The phenomenon is most noticeable in America, but is evident elsewhere, including in Australia.

A study tracking nearly 700,000 women in NSW hospitals, and published yesterday in the British Medical Journal, confirms this rising trend. It found that those women giving birth in private hospitals, despite being of similar age and health to first-time mothers in public hospitals, were 20 per cent less likely to deliver their first child vaginally. Indeed, just 15 per cent of women in private hospitals gave birth with no intervention, as opposed to 35 per cent in public hospitals - figures study leader Hannah Dahlen said were ''horrifying''.

Dr Dahlen, a professor of midwifery at the University of Western Sydney, is perhaps not an entirely dispassionate observer in the argument about the medical necessity of all caesarean births. She asserts that obstetricians have a tendency to see all births as risky until the baby is delivered, and that ''there is also strong incentive for surgeons to 'schedule in' women for induced births to make their workload and patient flow easier to manage''.

The suggestion that obstetricians might be scheduling their patients for C-sections in order to minimise inconvenience to themselves, or are being pressured into it by women who see it as a less troublesome or potentially disfiguring than vaginal birth, is of course vehemently rejected by the profession. However, convincing and credible explanations for the increase are difficult to unearth. There is not even any medical consensus about what the optimum C-section rate should be.

Like all surgical procedures, caesareans are not risk-free. They are also costly. It might be thought that governments and health insurance companies had a mutual interest in reducing the high rate of obstetrical interventions. But there is little evidence this is occurring, perhaps because of sensitivities about questioning the prerogative of doctors and surgeons to know best. There is, of course, another way around this problem - giving women full advice and support during their pregnancy, and apprising them of any risks so that they can make proper and informed judgments. That might include training more midwives and adopting one of Dr Dahlen's other suggestions of making public the intervention rates of obstetricians.

Unnecessary medical interventions are not limited to C-sections. They range from the prescription of antibiotics for colds, avoidable hospitalisation for nursing home patients, over-frequent cervical cancer screening, inappropriate hysterectomies, unnecessary admission to hospital of patients with chest pains, too many scans and inappropriate spinal fusion surgery for back pain, and they cost the country billions of dollars every year. The medical profession, at the behest of governments, needs to make greater efforts to minimise these taxpayer-borne losses.

Education divide

The ideological divide between Canberra's two major political parties is relatively narrow, but it is plainly on view in their school education policies. ACT Labor yesterday unveiled an $18.5 million package that takes its cue from the federal government's Gonski report, itself predicated on the need to encourage greater equity in enrolments in the non-government sector. The ACT Liberals have made the promise of an increase in funding to non-government schools (specifically Catholic independent schools) the central plank of their schools policy. The first stage of increase is expected to cost $31.4 million over four years, and though Opposition Leader Zed Seselja has pledged this it will not come at the expense of funding to government schools, the initiative has been much criticised by the Australian Education Union and public education advocates.

Catholic independent schools in Canberra are said to receive the second-lowest funding of any Australian jurisdiction, and it is understandable that the Liberals might be keen to attract parents whose children attend them. However, any perceptions they are neglecting the public education sector (which continues to lose students to the independent system) could cost more votes.