An extra €2 million was spent last year by the Government on unnecessary Caesarean births that could easily have been normal deliveries, according to the Malta Midwives Association.
The exorbitant number of Caesareans as well as the high rate of medical birth inductions also meant the 64 beds available at the hospital’s obstetrics ward were not enough to keep up with the demand, said association president Mary Buttigieg Said.
“The problem is that in Malta we consider pregnancy as an illness and not as the social event it is,” she told a conference entitled Normalising Childbirth in St Julian’s.
She said according to WHO guidelines, 25 beds in labour wards would be more than enough for the size of the population. But beds were being occupied for four extra nights due to Caesarean operations.
At 32 per cent, Malta has the highest rate of Caesarean sections in the EU.
WHO recommends an annual average of between 10 to 15 per cent.
A C-section costs the Government €3,867.29, which includes the operation and a six-night hospital stay, said Ms Buttigieg Said, basing her figures on bills foreigners paid when they used NHS services. A normal delivery only cost the Government €768.69 for assistance and a two-night stay.
The number of births in 2011 totalled 3,559. The association worked out that due to the 17 to 22 per cent extra Caesareans carried out unnecessarily, the Government ended up paying “some €2 million extra last year”.
“The extra cost can be invested in useful projects, such as the introduction of a midwifery-led model of care,” she said, adding this would include an hour-long antenatal visit allowing the mother to build a relationship with the midwife who would be assisting her during birth.
She pointed out that in 1996 the island’s Caesarean rate was 17 per cent. “It has now almost doubled and the mortality rate is the same,” she said, insisting this was further proof the increase in C-sections was futile.
“The problem is our mothers are too submissive. They do not question their consultants enough. And it is important that they participate more in their healthcare,” she said.
According to the association, Maltese women are being deprived of the right to be well informed, to be up to date on health matters, to participate actively in decisions about their healthcare and to offer informed consent.
“We are working hard to promote the well-being of the mother and child and we are calling on the Government to recognise and support accessible and effective midwifery care as a basic human right of all women, babies and midwives,” she said.
She quoted Dr Carol Sakala from the International Federation of Gynaecologists and Obstetricians, who claimed mother and babies benefited from waiting for labour to begin on its own and emphasised that induced labours should be avoided.
Women, Ms Buttigieg Said charged, were being “abused”, deprived of the most intimate and essential moments in their lives, and this might account for the high rates of cynicism, detachment, fatigue and burnout, seen increasingly in the modern healthcare system.
Short-term effects of unnecessary C-sections listed by the association included infections, post-partum haemorrhage, trauma to organs and a resistance to drugs.
Long-term effects could come to light should the mother need surgical intervention 10 or 15 years down the line.
The association said the more the midwife knew the mother during the antenatal process, the shorter labour would be.
“The midwife is the ambassador of physiological birth. Maltese midwives are being distinguished from their midwifery colleagues around the world who have the opportunity to care for the mother from the preconception period to post-birth,” she said.
She insisted she did not want this to turn into a tug-of-war between obstetricians and midwives: “We both need each other. The difference is we are experts of normal deliveries and obstetricians are the experts of deviation from normal deliveries.”
Midwives present at the conference were urged to be pillars for the mother in an effort to empower her.