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Deliveries in
Singapore: Volume & Resources |
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By Dr Ganga Ganesan1 |
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Abstract |
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This paper provides information on the volume and
resources for the two main types of delivery, Normal Delivery and Caesarean
Delivery. |
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Introduction |
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Most babies are delivered vaginally (also known as
‘Normal Deliveries’), just as nature intended. |
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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. |
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Volume of Deliveries |
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Total Volume |
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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%. |
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The total number of deliveries in each hospital is
shown in Table 1: |
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Volume of Deliveries by Type |
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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. |
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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%). |
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The Caesarean Section rate in each hospital is
shown in Table 2: |
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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. |
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Trend for Caesarean Sections |
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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). |
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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. |
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The risk of respiratory morbidity for the baby is
also higher for Caesarean Delivery (3.5%) compared with Normal Delivery
(0.5%). |
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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 |
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Resources |
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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. |
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Bill Sizes |
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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. |
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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. |
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Length of Stay |
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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. |
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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. |
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Conclusion |
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Normal Deliveries are generally safer, cost less
and require shorter recovery time compared to Caesarean Deliveries. |
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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. |
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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. |
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More..... (tables) |
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Feedback to MOH |
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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: |
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Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854. Tel: 6325 9220 Fax: 6224 1677. |
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Source:
MOH Information Paper 2004/06 |
Deliveries in Singapore: 2001 - 2003
