For well women giving birth for the first time, choosing a tertiary hospital environment increases the likelihood of intervention.

When women giving birth for the first time are well and their pregnancy has been without complications, home births and birthing units are safe options for them. Yet many women choose a tertiary hospital setting to give birth, with a greater clinical capacity than they are likely to need. This choice ironically means that these well women are more likely to have some kind of medical intervention. And medical interventions may contribute to negative birth experiences for women, which have implications such as increased risk of post-natal depression and greater difficulties breastfeeding, let alone the longer term implications for the health and well-being of their babies.

One of the Principal Lecturers in our School of Midwifery, Suzanne Miller, has been researching what it is about the hospital environment that contributes to more medical interventions. She undertook an audit of practice in one New Zealand tertiary hospital.  She found that 60% of low risk well women who arrived at the hospital already in labour with their first child were given some intervention to augment labour, for example having their waters broken or a drug administered by drip to speed labour up. She then turned to consider the hospital's policy about such interventions. Based on a sample, one third of these women were given an intervention unnecessarily, when the policy did not recommend it. Extrapolating from the sample, there were potentially another 270 women that year, in that hospital who also received an augmentation intervention that they did not need. Having an intervention like this makes further intervention more likely.

Birth interventions come at an economic cost to the public health system , but the social, emotional and physical costs for women and their whānau should also be considered as outcomes. Suzanne suggests women need to be aware that a tertiary hospital, which is geared up to deal with unwell women or complicated births and which provides a highly valuable service for such women, may paradoxically pose additional risks of unnecessary interventions for women who are well and anticipating normal births.  

Image credit: Lindsey Turner, used under Creative Commons licence CC BY 2.0

August 2019