On World Patient Safety Day tomorrow (17 September), the World Health Organization seeks to raise global awareness on the issues of maternal and newborn safety.

The recently-published Fourth Australian Atlas of Healthcare Variation has revealed that approximately half of the planned caesarean sections performed before 39 weeks did not have a documented medical or obstetric reason.

The Atlas is calling for action to reduce the rates of caesarean sections performed before 39 weeks without a medical or obstetric need because it increases the risk of adverse outcomes for children.

The Consumers Health Forum CEO Leanne Wells said: “We know that Australian caesarean section rates are high compared to most OECD countries. On World Patient Safety Day this year, we join the Atlas in calling for state and territory governments to support shared decision making with consumers and give parents and clinicians information about the risks (and benefits in some cases) of early planned birth.”

“We also know that required reporting of hospital caesarean section rates, including investigation of performance against the guidelines has discouraged variations in practice and contributed to slowing down the rise in caesarean sections.”

“We call on all states and territories to improve transparency and accountability around reporting in Australian hospitals to improve data collection and monitoring of where progress is being made and where more work is needed.”

The Atlas states that children born at 37–39 weeks accounted for 5.5% of cases of special educational needs, compared with children born preterm (less than 37 weeks gestation), who accounted for 3.6% of cases, in a study of Scottish schoolchildren.

Longer-term risks in children born before 39 weeks gestation compared with those born at full term include cognitive deficits and a higher risk of attention deficit hyperactivity disorder.

High caesarean section rates were just one example of the variations in treatments reported in the Atlas.

The report also shows that more than 330,000 potentially preventable hospitalisations in Australia in 2017–18 were partly due to: chronic obstructive pulmonary disease (COPD), kidney infections and urinary tract infections (UTIs), heart failure, cellulitis, and diabetes complications.

The findings in the Atlas underline the need for rigorous and continuing safety and quality monitoring of such treatments. 

It also shows the worth of patients being encouraged by their doctors to ask the Choosing Wisely five questions:

• Do I really need this test treatment or procedure?
• What are the risks?
• Are there simpler, safer options?
• What happens if I don't do anything?
• What are the costs?