Births are a common occurrence at the hospital. In fact in the Maldives, the most births occur either at IGMH or at ADK Hospitals. During the first six months of this year, a total of 2119 births, of which 855 (40%) occurred at ADK Hospital and 1264 (60%) occurred at IGMH.
When we look at the modes of delivery the combined rate of normal deliveries for both hospitals stand at 52%. The rate of normal deliveries at ADK is 46% while the figure for IGMH if 55%. When assisted deliveries are taken the rate stands at 0.7% with the ADK Hospital’s figure at 0.2% and at IGMH 0.9%.
In the case of vacuum deliveries, the combined rate for both hospitals stand at around 4%. However, a further breakdown shows that this figure is higher with 9% of all deliveries requiring vacuum at ADH Hospital while only 1% required the same at IGMH.
Cesarean sections can be said to be on the increase in the country as a whole. The combined cesarean rate for both hospitals is 43% for the referred period. Also the comparison between the two hospitals also does not differ with 44% and 43% at ADK Hospital and IGMH respectively. Over a year back, the cesarean rate for ADK Hospital was around 35% and although we do not have proper figures, anecdotal evidence suggests that it was the same case at IGMH as well.
This comparison was done as part of an analysis of services provided in the Maldives for the purposes of the ADK Hospital’s development project currently being undertaken. It is unfortunate that these types of analysis are not done more often. This little analysis already gives some light to the situation of deliveries and the modes of if for the two major hospitals. It gives a learning opportunity for both hospitals, to see where each other is doing better or worse and to look positively and identifying and improving any shortcomings.
The available data allows more indebt analysis that can be used as further evidence for quality improvement. The Hospital intends to conduct similar analysis for different specialties in future. Unless evidence and information use increases in healthcare, quality cannot be improved. There are indications in this very basic analysis, where ADK Hospital can attempt to further improve and also to identify areas for patient education as well.
However, it is not enough for hospitals alone to do patient education on matters such as this. There needs to be national guidelines and recommended rates of Caesarean sections for the country. As I understand, the WHO standard for Caesarean sections is 10%. This is a figure way below the Maldives average. In fact this is a rate that no country in the world probably would achieve at this day and age. Perhaps, WHO should look at revising this rate and also this matter is now on the books of that organisation.
For the Maldives, we need to gather experts and brainstorm on the reason for this higher rate of Caesarean sections. In some countries, it is said that Caesareans are comparatively higher in private sector where doctors are incentivised to conduct surgeries and hence produces a supply induced demand whereas in the public sector salary based employment, there is no incentive to do surgeries. However, in the Maldives, there is no difference among the sectors as can be seen from the data.
More needs to be done of patient education and encouraging families to opt for normal deliveries. Obviously the natural process of birth will have many advantages compared to a more risky surgery. Also, in case women opt to take up Caesareans due to pain, in the modern world normal deliveries can be pain free with local anaesthesia or epidurals. Also new concepts such as water births could also be tried out.