Local obstetricians will not apologise for Malta having the highest rate of induced births in Europe, according to consultant Mark Formosa, who insists local obstetric numbers for mortality and morbidity speak for themselves.
“This (final stage of pregnancy) is a very hazardous period for the (baby) and one cannot be either complacent or flippant,” Mr Formosa said, referring to the 2008 Euro-Peristat report, which states that mortality during birth and the first month of life is higher than in any other period, excluding old age.
Mr Formosa, who is also secretary of the Malta Royal College of Obstetricians and Gynaecologists, pointed out that in spite of interventions, which he emphasised doctors “are very proud of”, the one problem which continues to elude them is the unexplained still birth – the sudden death of a baby in utero for no explained reason.
Because of this, doctors will deliver the baby “if there is the slightest risk”, Mr Formosa said, giving this as the single most important reason for Malta’s induction rate.
The issue of induced births surfaced earlier this month as the Malta Union of Midwives and Nurses threatened industrial action if the number of induced births was not controlled, and it accused doctors of abusing the system.
“Obstetricians, like all clinicians, do not all operate in the same way, but we definitely all have the interest of the patients first and foremost and no accusation of putting money first can ever be ignored or accepted by the college,” he said, rejecting reports that doctors were trying to safeguard their private practices.
Mr Formosa said Malta had a very particular population of mothers which were high risk, pointing to short stature, a high rate of diabetes in pregnancy (which stands at 16 per cent), obesity and older mothers as indicators of probable problematic pregnancies.
It was important to realise, he said, that when dealing with women who had problems trying to conceive or had previous miscarriages, anxiety levels were high and treatment had to include a patient’s psychological state.
“For someone who has had three miscarriages, is on medication, and has been thinking for nine months that she is going to lose this baby as well, it does not make sense telling her that you cannot induce at 40 weeks because we have to wait till 41,” he said.
“The only healthy baby is one which has been delivered,” Mr Formosa emphasised, pointing out, however, that any maternal wishes for a natural birth, if considered safe, were never denied.
He referred to a study, published in the British Medical Journal on maternal health services in the Netherlands, which were mainly run by midwives.
The Netherlands, he said, had one extra still birth per 1,000 deliveries compared with the European average. The latest study of the Dutch system, published in December, found that in the low risk group of mothers being cared for by midwives, the death rate was 2.3 times higher than the high risk group, which was being cared for by a team of obstetricians and midwives.
“We believe in teamwork with midwives and we believe this should continue to be strengthened,” he said, but cautioned towards any changes in the current health system, which he said would be a leap in the dark, possibly away from the good local statistics.
Malta ranked eighth worldwide for maternal deaths and the foetal death rate was also low at 3.6 per 1,000 births, which compares well with the Netherlands’ figures of seven per 1,000 births, he said.
Birth injury to large babies has been brought down by 60 per cent over the last 30 years, he said, pointing out that no obstetrician was going to apologise for an intervention that had allowed a baby to live a healthy life.
“Our intervention has led to these results. We certainly should, I agree, try to make childbirth as pleasant for the mother as possible, but it would be a mistake to ignore the Persitat statement that this phase of life is the most dangerous, other than old age,” Mr Formosa said.