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Legislation to stop planned births before 39 weeks without a medical or obstetric indication, is one of the recommendations made in the newly released Fourth Australian Atlas of Healthcare Variation.

Published by Australian Commission on Quality and Safety and the Australian Institute of Health and Welfare, the recommendation was reached on the back of data that showed between 43% and 56% of planned caesarean section births performed before 39 weeks in 2017 did not have a medical or obstetric reason, potentially putting many newborns at unnecessary risk.

Additionally, of particular concern, was 13 to 19% of all planned caesarean sections performed before 37 weeks did not have a recorded medical or obstetric reason.

The Atlas stated this was despite clear evidence that waiting until 39 weeks, unless there is a medical reason not to, is best for the baby.

Professor John Newnham AM, Senior Australian of the Year 2020 and Professor in Obstetrics & Gynaecology at The University of Western Australia said unnecessary early birth can have a range of consequences, from higher risks of respiratory problems at birth to higher risks of behavioural and learning problems in the long-term.

“Every week counts towards the end of pregnancy” he advised, adding that the risks to the newborn are greater at 37 than 38 weeks, and greater at 38 than 39 weeks.

Factors likely to influence the rates of early planned births include how the birth is funded, the hospital’s location, operating theatre capacity, organisational culture, and policies and guidelines.

To address this issue, the fourth Atlas recommended universal changes to government, hospital and insurer policies to stop booking of planned births before 39 weeks without a medical or obstetric indication.

Professor Newnham said policy change was essential.

“It is also important for parents to have accurate information about the risks and benefits of early planned birth, and access to clinicians and facilities at the right time,” he said.

“I encourage parents to ask questions before booking an early caesarean section, to make sure their birth plans are best for both mother and baby.”