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     FrontPage Edition: Thu 16 December 2004

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Deliveries in Singapore: 2001 - 2003

Deliveries in Singapore: Volume & Resources

By Dr Ganga Ganesan1

Abstract

This paper provides information on the volume and resources for the two main types of delivery, Normal Delivery and Caesarean Delivery.
Introduction
Most babies are delivered vaginally (also known as ‘Normal Deliveries’), just as nature intended.
However, when the health of the baby or mother is at risk, obstetricians can deliver the baby surgically. This is referred to as delivery by Caesarean section.
Volume of Deliveries
Total Volume
There were a total of 120,788 deliveries in Singapore for the three year period of 2001 to 2003. Public hospitals accounted for 47.2% of total deliveries while private hospitals accounted for 52.8%.
The total number of deliveries in each hospital is shown in Table 1:
Volume of Deliveries by Type
Of the total number of deliveries in Singapore for the three year period of 2001 to 2003, 69.5% (or 83,996) were Normal Deliveries while 30.5% (or 36,792) were Caesarean Deliveries.
While the majority of deliveries in both public and private hospitals were Normal Deliveries, the Caesarean Section rates (i.e. number of Caesarean Deliveries as a percentage of Total Deliveries) were generally higher in the private hospitals (average 35.3%) compared to the public hospitals (average 25.1%).
The Caesarean Section rate in each hospital is shown in Table 2:
The Caesarean Section rates observed locally in public sector hospitals are similar to the experience recorded in other countries: US 26.1% (2002); UK – Wales 24.2%, Ireland 23.9%, England 21.3%, (2001)3; Denmark 17.6% (2002); Finland 16.1% (2002) and Australia 21.6 (2001).4 The Caesarean Section rates for private sector hospitals are however in general higher than the rate in these countries.
Trend for Caesarean Sections
There is a rising trend in Caesarean Section rates locally over the past 15 years (see Fig 1). The rising trend in Caesarean Section rates is similar to the experience recorded in other countries (some countries in the West have recorded even higher rates of increase, e.g. an increase of 7% in the US from 2000 to 20015).
This trend is of concern as Caesarean Deliveries are not without risk. Although the absolute risk is small, studies have shown that the overall maternal morbidity is higher with elective (ie planned) Caesarean delivery in terms of anaesthetic and surgical risks (e.g., the risk of bladder injury is 0.1% for Caesarean Delivery compared with 0.003% for Normal Delivery) and implications for future pregnancies (e.g., the risk of placenta previa, a condition in which the placenta covers the entrance to the womb, in a future pregnancy is 0.7% for Caesarean Delivery compared with 0.5% for Normal Delivery)6.
The risk of respiratory morbidity for the baby is also higher for Caesarean Delivery (3.5%) compared with Normal Delivery (0.5%).
However, in specific circumstances where Caesarean deliveries are medically indicated such as breech presentations, the perinatal morbidity and mortality are lower in planned Caesarean Deliveries (1.6%) compared to planned vaginal births (5.0%).7
Resources
Normal Deliveries and Caesarean Deliveries were also compared from the point of view of resources consumed, looking specifically at Bill Sizes, and Average Lengths of Stay. To ensure a ‘like-for-like’ comparison, Bill Sizes and Average Lengths of Stay for Ward Class A (1-2 bed) in public hospitals were compared with bills for 1-bed wards in private hospitals.
Bill Sizes
The bill sizes for Normal Deliveries are lower than those for Caesarean Deliveries. This is in line with the lower levels of resources consumed for the former.

The 50th percentile bill sizes8 for the two modes of delivery ranged from:

a) $1,970 to $4,029 for Normal Deliveries (without complications), and

b) $4,331 to $6,381 for Caesarean Deliveries (without complications).

See Table 4 for details.

Length of Stay
The Average Lengths of Stay for Normal Deliveries are lower than those for Caesarean Deliveries. This is in line with the shorter recovery times for patients undergoing the former.

The Average Lengths of Stay8 for the two modes of delivery ranged from:

a) 1.94 to 2.59 days for Normal Deliveries (without complications), and

b) 3.23 to 4.09 days for Caesarean Deliveries (without complications).

See Table 5 for details.

Conclusion
Normal Deliveries are generally safer, cost less and require shorter recovery time compared to Caesarean Deliveries.
While it is difficult to define the Caesarean Section rate for “optimal” care, comparison with developed countries suggests that our national figures may be at the higher end of the spectrum.
Delivery by Caesarean Section is considered on a case-to-case basis after weighing the associated risks and benefits to the baby and mother. A Caesarean Delivery should not be done just because it is easier to schedule but based on medical indications. Expectant mothers are advised to consult their doctor and be informed of the likely risks and benefits of undergoing a Caesarean Delivery.
More..... (tables)
Feedback to MOH
If you have any comments or questions on the information paper, you can email us directly at moh_info@moh.gov.sg. Alternatively, you can also fax or write to us at:
Ministry of Health, College of Medicine Building, 16 College Road, Singapore 169854. Tel: 6325 9220 Fax: 6224 1677.

Source: MOH Information Paper 2004/06

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