NW has amongst lowest C-section rates

'Safer Births: Using information to Improve Quality' has been newly published by the Northern Ireland Audit Office (NIAO).
'Safer Births: Using information to Improve Quality' has been newly published by the Northern Ireland Audit Office (NIAO).

The maternity unit at Altnagelvin had the second lowest caesarean rate in Northern Ireland last year as the Northern Ireland Audit Office (NIAO) warns unnecessary C-sections may be putting mothers and babies at risk.

‘Safer Births: Using information to Improve Quality,’ which was published on Tuesday (April 29) reveals that there were 2,762 births in Altnagelvin in 2012/13 and that 713 of these (25.8 per cent) were caesarean deliveries.

That was the lowest rate of any hospital in Northern Ireland with the exception of the Mater Infirmorum in Belfast (22.9 per cent).

The report also reveals that the Western Trust as a whole had the second lowest C-section rate (26 per cent) of any Trust in Northern Ireland.

Referring to the figures for Northern Ireland as whole, which reveal significant variation between maternity wards, the authors state: “These initial observations focus only on the more obvious findings.

“On their own, the variations revealed in these figures are not an indicator of the quality of care.

“To gain further insight clinical managers need to examine the comparative rates in relation to information on other factors such as age, height body mass index, relevant medical conditions, ethnicity, gestational age and condition of the foetus and other case mix variables.”

The report recommends the adoption of a sophisticated women-based classification system developed by Dr Michael Robson from the National Maternity Hospital in Dublin, to properly understand variations from unit to unit and Trust to Trust.

The Ten Group Classification System (TGCS) permits standardised auditing within, and between, maternity units by limiting comparisons to clinically relevant groupings, the report explains.

TGCS is unique in that it only compares outcomes of women with similar obstetric characteristics.

Comptroller and Auditor General, Kieran Donnelly, said: “Caesarean sections undoubtedly save lives and should be performed in all cases where there is a clinical need.

“However, performing unnecessary caesarean sections poses health risks for the mother and baby and incurs additional costs.”

The risks cited in the report include the avoidable risk of infection and extended hospital stays and recoveries.

However, the cost to the taxpayer is also alluded to, with the report pointing out that caesarean sections typically cost the health service almost twice that of a normal delivery - £3,724 compared to £1,933.

Mr Donnelly continued: “In the current financial climate it seems particularly important that clinical managers in the HSC Trusts understand and manage the cost implications of different modes of child birth.

“The use of a classification system such as that demonstrated in this report will be an essential aid in assisting HSC Trusts to verify that resource allocations id determined on the basis of clinical decisions.”