Caesarean Birth in SA

The following information relating to documented pregnancy outcomes in South Australia in 2009 has been taken from:

Chan A, Scheil W, Scott J, Nguyen A-M, Sage L. Pregnancy Outcome in South Australia 2009. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2011.

“Caesarean section was performed in 6,357 women who gave birth (32.4%), of which 3,084 (15.7%) were elective, and 3,273 (16.7%) emergency operations.” p. 81

“The main reasons given for all caesarean sections were previous caesarean section (38.7%), failure to progress/cephalopelvic disproportion (CPD) (26.8%), fetal distress (15.5%) and malpresentation (11.5%)… The main reasons for elective sections were previous caesarean section (67.6%), malpresentation (13.3%) and multiple pregnancy (2.5%)… The main reasons given for emergency sections were failure to progress or CPD (49.9%), fetal distress (30.1%), previous caesarean section (11.5%) and malpresentation (9.7%).” p. 34

“The proportion delivered by… caesarean section [increased] from 16.9% in 1981 to 32.4% in 2009. The caesarean section rate has been relatively stable for the last five years.” p. 74

Caesarean Birth Categorisation

The following information can be read in full in the government’s Standards for Maternal and Neonatal Services in South Australia 2010.

If your chosen hospital conducts deliveries as part of their maternity service, it should have the appropriate staff and resources to perform a safe and prompt Category 1 Caesarean section delivery. It is worth asking about the resources available in your hospital of choice and under which circumstances a transfer to a higher level facility would be required. If your hospital does not have the ability to perform Category 1 Caesarean sections, you need to consider how this might affect their practice and their treatment of you as a patient.

The classifications of each Caesarean sections are currently as follows:

Category 1: Immediate threat to life of a woman or foetus

  • cord prolapse
  • failed instrument delivery with foetal compromise (bradycardia or low pH)
  • maternal arrest
  • abnormal foetal scalp blood sample/pH (pH<7.2)
  • confirmed foetal blood (Apt’s test) indicating ruptured fetal blood vessel
  • sustained foetal bradycardia (<70/min for ≥ 3minutes)
  • placental abruption
  • placenta praevia with major haemorrhage

Category 2: Maternal or fetal compromise but not immediately life threatening

  • identified, but reversible abnormality on the cardiotocographs
  • malpresentation of the foetus

Category 3: Needing early delivery but no maternal or fetal compromise

  • failure to progress
  • malpresentation in early labour
  • planned Caesarean section presenting in labour
  • maternal condition requiring stabilisation (i.e. preeclampsia)

Category 4: At a time to suit the woman and the Caesarean section team