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Defensive medicine is alive and well in
Canberra
Denise
----- Original Message -----
Sent: Thursday, January 24, 2002 8:17
AM
Subject: More from the CT - The OB's have
their say..........
Letters to the Editor
(24/1/02)
Thursday, 24 January 2002
These women likely to need
caesareans
DR BARBARA VERNON of the Maternity Coalition (CT, Letters,
January 17) disagrees in part with the sentiments of Dr Heather Munro upon her
retirement. As you might expect I find myself totally in agreement with Dr
Munro, as I imagine would most practising obstetricians.
Dr Vernon lauds
the Canberra Hospital and its alternative birthing programs and suggest that
the caesarean rates are lower than in the private system.
Since a large
number of well educated women, particularly the older ones or those with
particularly precious pregnancies who are more likely to require caesareans,
tend to go to experienced private obstetricians for their confinement, Dr
Vernon is committing (presumably deliberately) the first sin of statistics,
namely, the presentation of data derived from the comparison of dissimilar
groups.
She also very neatly (and since I can't believe it's due to
ignorance I presume it's deliberate) omits all reference to maternal and baby
mortality and morbidity, morbidity being roughly defined as temporary or
ongoing illness, disability or other symptoms as a result of
confinement.
If she wishes to appear objective and unbiased, I would
suggest that not only should she compare similar groups to produce her
figures, but that she should also compare mortality and short and long term
morbidity in the public and private systems.
She might be quite surprised
at the results derived from this latter exercise.
M. A.
STAFFORD-BELL
Deakin
More seeking intervention
AS A GP who
practised obstetrics for over 25 years I take issue with the letter of Dr
Barbara Vernon (CT, January 17).
Taking the raw figures for caesarean
sections from different hospitals and making sweeping statements is
unscientific. The types of cases managed in different centres dictates the
rate.
Many women are choosing intervention. Some are primigravidas (first
pregnancies) and have heard about the terrors of labour. Others have
experienced a difficult labour and do not wish to do so again. In either case,
a vaginal delivery would be desirable from the obstetric viewpoint but in this
day of choice they insist on (and receive) a caesarean section.
The
statement that ''caesarean is riskier than vaginal birth for both mother and
baby'' is, overall, certainly the case. However, if a patient has
complications, then caesarean section has far less risk for both mother and
baby than continuing labour. Obstetricians do not intervene for other than
good, sound, medical reasons (with the exception stated above).
The
maternal deaths, neonatal deaths and morbidity statistics in Australia and
overseas also require examination before accepting any of Dr Vernon's
assertions in these areas.
Obstetrics is a high-stress area of medicine.
Those who devote their life to the specialty deserve more support than Barbara
Vernon's diatribe.
Dr ALAN D. SHROOT
Aranda
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