Induced births and high rate of births by Caesarean section

Consultant Mark Formosa, secretary of the Malta representative committee of the Royal College of Obstetricians and Gynaecologists (The Sunday Times, January 16), stated that “local obstetricians will not apologise for Malta having the highest rate of induced births in Europe”.

Midwives have not asked the obstetricians to apologise for their past practice but have asked for a review of practice which will benefit both mothers and babies.

Various studies have shown that fewer interventions, fewer Caesarean sections and more natural births means that mothers will recuperate better and faster and we will have fewer babies with asthma and other problems.

A Norwegian study based on 1.7 million births and followed up to 18 years, showed that babies born by C-section have a 50 per cent higher risk of developing asthma when compared with babies born naturally.

Obstetricians know very well that the rate of induced labour and C-sections is too high in Malta. We are told that we have “a very particular population of mothers which were high-risk”. The only increased risk in Maltese women compared with women in other European countries is diabetes.

Again, women are led to believe that if they are short they will need a C-section. Women who are less than 150 cm and have an adequate pelvic structure give birth naturally. Women need to be given the right information and empowered to make the right decisions.

Midwives are trained to care for women during pregnancy, labour and the postnatal period. They are also trained to detect deviations from the normal and they refer these women to the obstetrician.

No midwife will ever think of questioning why a mother who is considered to have a high-risk pregnancy has induced labour. In fact most of these mothers are induced at 37 to 39 weeks and not at 40 weeks.

Mr Formosa also mentioned the study referring to the higher foetal death rate in 30 per cent of home births in Holland when compared with hospital births. I am not going into the analysis of the rates of the original Dutch study. Its authors have already commented that it was wrongly used and that they were never contacted to give more details about their data.

I could not see the relevance of the Dutch situation to Malta. I have never heard Maltese midwives say anything about home births although I believe that this is an option that Maltese women should have.

Midwives have been asking for midwife-led care with fewer interventions and referrals to the medical team if expected progress is not within the agreed parameters.

Obstetricians will eventually have more time to dedicate to the women who have a problematic pregnancy.

If we, as healthcare professionals, honestly believe that we want the best for the women we care for, then midwife-led care and hospital births attended by midwives is the best option which needs to be implemented immediately.

It is important to note that hospitals in Nordic countries, with the same number of births as in Malta and with the same number of delivery rooms and maternity beds, never experience problems with bed shortages because they have the model of care being proposed above.


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