Move to stop elective caesarean births before 39 weeks

Medicare benefits and insurance payments would be stopped for caesarean births at less than 39 weeks without a medical reason under radical new recommendations.

A growing trend towards new mums opting for early elective C-sections needs to be stopped, experts say.

Experts say evidence gathered in the past decade shows such births put babies at risk of life long problems including attention deficit disorder and are calling for changes to stop such deliveries unless there is a medical reason.

More than half of elective caesarean births in South Australia done before 39 weeks gestation in 2017 had no medical reason recorded.

Key recommendations in a new federal report include withholding Medicare benefits and private health insurance payments from July, 2022 for such births, audits of clinicians to see who are delivering early, and forcing hospitals to record them as birth complications and policies to stop bookings for elective C-sections before 39 weeks unless medically indicated.

Professor John Newnham. Picture: AAP Image/Mick Tsikas

Full term is considered to be in the 37-41 week age range while less than 37 weeks is considered preterm, however the Australian Commission on Safety and Quality in Health Care report says there is clear evidence that waiting until 39 weeks is best for the baby unless there is a medical reason not to do so.

New data in its fourth Australian Atlas of Healthcare Variation released today shows 56.1 per cent of all planned C-sections in SA done at less than 39 weeks in 2017 were done without a medical or obstetric indication, a total of 1322.

It also shows 30.9 per cent done at less than 38 weeks and 18.5 per cent done at less than 37 weeks do not have a medical or obstetric indication.

Obstetrician Professor John Newnham AM, Senior Australian of the Year 2020, wants births at 37-38 weeks relabelled “early term.”

He says evidence which emerged a decade ago shows the final weeks are critical and unnecessary early birth can have risks ranging from respiratory problems to behavioural and learning difficulties.

“While at times early birth is necessary, all too often it occurs without a medical or obstetric reason,” he said.

“The evidence is clear that waiting until at least 39 weeks is best for the baby’s development, unless there is a medical reason for an earlier birth.

“Babies put on 50 per cent more brain mass between 37-39 weeks and that plays out at school age with behavioural problems and learning difficulties.

“The evidence emerged a decade ago but I don’t think the message has sunk in how important those finals weeks are — a good number of behavioural problems in school aged children are linked to early term births and they are totally preventable.”

Commission officials say factors likely to influence the rates of early planned births include how it is funded, the hospital’s location, operating theatre capacity, organisational culture, hospital policies — and convenience for mothers and clinicians.

Two thirds of women opting for an elective said having a previous C-section was the main reason, followed by malpresentation (12.1 per cent) and hypertensive disease (5.6 per cent).

Originally published as Move to stop elective caesarean births before 39 weeks