The calls from the National Association of Specialist Obstetricians and Gynaecologists, the Colorectal Surgical Society of Australia and New Zealand, and the Urological Society of Australia were in response to an exclusive investigation by this masthead into the rising rate of tears during childbirth across Australia.<\/p>\n
NASOG chairwoman Dr Elizabeth Jackson said the wide variation in birth injury rates between hospitals needed to be investigated, not to assign blame, but to improve outcomes for women.<\/p>\n
\u201cIf a woman\u2019s risk of sustaining a major birth injury changes substantially depending on the hospital in which she gives birth, we need to understand why. Not to apportion blame \u2014 to actually look,\u201d Dr Jackson said.<\/p>\n
She said while there were legitimate reasons for variation in rates of third- and fourth-degree tears between Australian maternity services, including maternal age, BMI and diabetes, it needed to be determined if hospital, clinical and system factors were contributing to this.<\/p>\n
\u201cIf we are serious about understanding why outcomes differ, we need considerably more detail about what is happening during birth,\u201d she said.<\/p>\n
In a jointly released position statement, the bodies said: \u201cWomen have the right to expect that evidence-based strategies to minimise preventable birth injury are consistently applied regardless of where they give birth in Australia.\u201d<\/p>\n
The bodies have called for nine recommendations to be adopted.<\/p>\n
This includes having a system in place to review maternity services that have \u201coutlier\u201d rates of birth injuries.<\/p>\n
They also say an independent review should be automatically triggered if the rate of severe tears at a hospital exceeds 5 per cent.<\/p>\n
Another recommendation is that every woman who sustains a severe tear undergoes a structured review, examining whether recognised risk factors were identified and appropriately managed, and whether the care she received was appropriate.<\/p>\n
It comes after a five-week investigation by this masthead revealed the rates of tears \u2013 which vary from a small graze to a laceration that requires surgery \u2013 at more than 100 hospitals and 24 health districts across the country.<\/p>\n
National figures show four in five women who give birth vaginally sustain some form of tear, which can take up to three months to heal.<\/p>\n
The data from the Australian Institute of Health and Welfare shows an almost seven-percentage-point rise in the rate of women suffering a tear to their perineum (the area between the vagina and anus) during natural childbirth over the last 10 years. In 2023, 82 per cent of births involved some form of tear, compared with just 75 per cent in 2014.<\/p>\n
Nationally, 2.7 per cent of women who gave birth vaginally had a third or fourth-degree tear. The rate varied significantly across states and territories \u2013 from a high of 4 per cent in the Northern Territory down to 2.5 per cent in Western Australia. The Australian Capital Territory (3.5 per cent), Tasmania (3.1 per cent), South Australia (2.9 per cent), Queensland and Victoria (2.8 per cent each) and NSW (2.6 per cent) fell in between.<\/p>\n
Brisbane-based colorectal surgeon Dr Chris Gillespie said lots of his patients suffered with bowel dysfunction after birth trauma.<\/p>\n
\u201cWe deal with problems with bowel function,\u201d said Dr Gillespie, who is also treasurer of the Colorectal Surgical Society of Australia and New Zealand.<\/p>\n
\u201cProblems with faecal incontinence and defecatory dysfunction are very debilitating.\u201d<\/p>\n
He said women who suffered third- and fourth-degree tears due to obstetric trauma formed a large portion of these patients, and often suffered greatly, requiring extensive medical care and treatment.<\/p>\n
\u201cSimply put \u2013 prevention of obstetric trauma will lead to fewer incidences of faecal incontinence, defecatory difficulties and prolapse problems for our future population, and will be of benefit to society and the community by preventing obstetric trauma and its long-term consequences,\u201d Dr Gillespie said.<\/p>\n
\u201cI echo the statement that good data and evidence around the link between obstetric trauma and functional issues many years later is still relatively poor, and that further longitudinal research will greatly add to our understanding of this link and the importance of prevention.\u201d<\/p>\n
Dr Jackson said: \u201cFundamentally, birth is safe in Australia overall. But when we see these differences between different health services, we need to look at why, and we are calling for greater governance that goes beyond benchmarking.\u201d<\/p>\n
She said the group was calling for \u201cthe next level of database, which is a national clinical quality learning registry, but we need uniformity nationally in data collection\u201d.<\/p>\n
\u201cThis is not about apportioning blame \u2014 we look to IVF in Australia, and the information a patient can access before making a decision about their fertility treatment is exceptional, whereas at the other end \u2014 the decision to inform birth care \u2014 that information is not readily available to the community in a single, readable database.\u201d<\/p>\n
A spokeswoman for the Australian Commission on Safety and Quality in Health Care said it was recognised that severe obstetric perineal injury and perineal tears were \u201csignificant patient safety issues\u201d.<\/p>\n
She said they had developed the first national third and fourth degree perineal tears clinical care standard in 2021 to improve the consistency and quality of care for the prevention, recognition and management of these injuries.<\/p>\n
\u201cThe commission also continues to monitor birth trauma and perineal tears through its hospital-acquired complications program, which supports the collection and analysis of national data to identify variation, enabling health services to track outcomes and drive improvements in patient safety and maternity care,\u201d she said.<\/p>\n
She would not say if the commission was looking to investigate a new database.<\/p>\n","protected":false},"excerpt":{"rendered":"The calls from the National Association of Specialist Obstetricians and Gynaecologists, the Colorectal Surgical Society of Australia 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