An inquest into baby Nixon’s death has heard that requests for caesareans are ‘frowned upon’ across Queensland Health because they are less cost-effective and carry greater risk.
First-time mum Simone Tonkin had to undergo an emergency caesarean at Royal Brisbane Women’s Hospital in June 2014 after her son, Nixon got stuck in the birthing canal.
Shortly after delivery, Nixon died due to skull fractures, hemorrhaging and brain swelling, possibly caused by the midwife’s fingers pushing against his head to reverse the obstruction.
An obstetric registrar told an inquest on Tuesday that Mrs Tonkin did not meet any of the guidelines for a caesarean section. During her pregnancy, she had gestational diabetes, hypertension, depression and was carrying a large baby.
The registrar said she believed requests for caesareans were ‘frowned upon’ across Queensland Health because normal vaginal births were ‘more cost effective’. “There’s always a pressure to aim for vaginal birth over caesar,” she said, adding that as a major surgery, caesareans have more side effects and a possible financial burden for patients. “A normal vaginal birth is the best outcome but an emergency caesar is the worst outcome, so it’s a grey area in between,” she said.
However, an obstetric consultant told the inquest she had not found cost effectiveness to have been an issue in her experience.
The court heard that the World Health Organisation’s guidelines state that caesareans should only be carried out when medically necessary.
The registrar also noted that RBWH was more than willing to do caesareans than other places because of staff ethos.
In a statement, clinical director of obstetrics and gynaecology Karin Lust said cost was never a factor when deciding whether to carry out a caesarean section. “As we’re a public quaternary acute hospital caring for a number of high-risk pregnant patients, our caesarean numbers are often higher than the state average,” she said.
The inquest continues.