healthy birth without invasive medical intervention

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Obstetrical intervention rates in Germany are among the highest in Europe... considerable overtreatment of low risk mothers... strengthening normal physiological proccesses and avoiding unnecessary interventions.


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Obstetrical intervention rates in Germany are among the highest in Europe. The aim of this investigation is to show the development of obstetrical intervention rates as well as neonatal and maternal outcomes. The focus is to determine subgroups of pregnant women who are particularly affected by high intervention rates and to identify predictor variables for the most important obstetrical interventions.

The Lower Saxony Perinatal Survey is used for retrospective secondary analysis. Data from 1984-1999 (in total more than 1 million cases) are used for descriptive and bivariate analysis, and 1999 data for multivariate methods (as a result of modifications since 2000 the surveys no longer provide all variables needed). Results of the years 2000-2006 are included in the discussion. Over-standard use of medical care was found to be increasing during the period investigated. This finding related to antenatal care as well as to most obstetrical interventions. However, the low risk group showed a steeper rise in growth ratio compared to the high risk group (according to the WHO definition). Whereas the proportion of deliveries without invasive medical intervention declined to 6,7% in 1999, there was no proportional improvement of neonatal and maternal outcomes. During the most recent years even a slightly adverse trend especially in the low risk group was detected. Older age of the mother was not confirmed as an independent risk factor.
Although older mothers showed higher intervention rates, age hardly seemed to be of any explanatory value for the probability of the interventions. In contrast, the probability of both assisted deliveries and caesarean sections after onset of labour was increased by previous interventions (particularly augmentation of labour). The most essential predictor variable for induction of labour was early admission to the labour ward (cervical dilatation 1 cm or less). Additionally, documented reasons for surgical delivery modes showed an overall increase in soft indications, particularly for the term “miscellaneous” which multiplied itself. In conclusion there is evidence of inappropriate health care utilisation in the obstetric field. In particular, there was considerable overtreatment of low risk mothers and weak evidence-base in usual practice. In terms of appropriate health care – particularly for the majority of healthy mothers with normal pregnancies and straightforward births – it is essential to provide health care services that are able to “keep birth normal” by strengthening normal physiological proccesses and avoiding unnecessary interventions.

Institutional structures supporting a salutogenetic approach, evidence based guidelines, and information are still lacking. Further a correction of the financial incentive system is needed.


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