Text 1 Abstract – Medical Journal of Australia.

With approximately 25% of all births in Australia being by caesarean section (CS), we
have one of the highest rates among First World countries. There are, of course,
variations from State to State and between the public and private sectors, but this high
average rate is of ongoing concern to obstetricians, health administrators and
consumer groups. Many reasons for these high rates have been advanced, including
better survival prospects for very preterm infants; the threat of litigation leading to
earlier intervention in labour; fewer operative vaginal deliveries; and routine
abdominal delivery for breech presentation. The widespread use of electronic foetal
monitoring and epidural analgesia, and the need for repeat CS, have also been cited.
Despite much discussion, the appropriate CS rate for any population has yet to be
defined; for instance, the target CS rate set by the US Department of Health and
Human Services of 15% of births is an arbitrary figure widely questioned by
obstetricians in the United States.

Text 2 Key Facts in the UK Hospital system

Between 2005-06 and 2006-07:

 the number of deliveries taking place in NHS hospitals in 2006-7 increased
by 2.9 per cent (629,207) compared to 2005-6 (611,337)
In 2006-07:
 over 20 per cent of labours were induced.
 the caesarean rate remained stable in 2006-07 at 24.3 per cent (this was 24.1
per cent on a comparable basis in 2005-06); more than half these were
emergency caesareans.
 11.5 per cent were instrumental deliveries
 an estimated 52 per cent of deliveries were ‘normal deliveries' defined as
those without surgical intervention, use of instruments, induction, epidural, spinal
or general anaesthetic
 most women with spontaneous deliveries spent 0 or 1 day in hospital after
delivery, women with instrumental deliveries 1 or 2 days and women with
caesarean deliveries between 2 and 3 days
 recovery time in hospital following caesarean section is lessening.
Approximately one quarter (27,407) spent four days or more recovering in hospital
in 2006-07, compared to just under a third (31,393) in 2005-06
TEXT 3 Definition of Caesarean Section

A Caesarean section, also known as C-section or Caesar, is a surgical procedure in

which incisions are made through a mother's abdomen (laparotomy) and uterus
(hysterotomy) to deliver one or more babies. It is usually performed when a vaginal
delivery would put the baby's or mother's life or health at risk, although in recent
times it has been also performed upon request for childbirths that could otherwise
have been natural. The World Health Organization (WHO) recommends that the rate
of Caesarean sections should not exceed 15% in any country. However, in recent
years the rate has risen to a record level of 46% in China and to levels of 25% and
above in many Asian countries, Latin America, and the USA.

Text 4 Report of the US National Institutes of Health.

The US National Institutes of Health says that rises in rates of caesarean sections are
not, in isolation, a cause for concern, but may reflect changing reproductive patterns:

‘Some authors have proposed an “ideal rate” of all cesarean deliveries (such
as 15 percent) for a population. There is no consistency in this ideal rate, and
artificial declarations of an ideal rate should be discouraged. Goals for
achieving an optimal cesarean delivery rate should be based on maximizing
the best possible maternal and neonatal outcomes, taking into account
available medical and health resources and maternal preferences. Thus,
optimal cesarean delivery rates will vary over time and across different
populations according to individual and societal circumstances.’
Reading – Subtest A
Caesarean Section
Complete the following summary using the information in the texts provided. You do
not need to read each text from beginning to end to complete the task. You should
scan the texts to find the information you need. Gaps may require 1, 2 or 3 words. You
should write your answers next to the appropriate number in the right hand column.
Use correct spelling and grammar– marks will be lost if there is incorrect spelling or
grammar.
Please write legibly.
Summary Task

10

11

12

13

14

15

Caesarean section is (1) procedure to deliver a baby or babies by an (2) incision, also
known as laparotomy, and a (3) (an incision through the uterus). It has traditionally
been done when the life or health of (4) or baby is at risk, but is now being done more
(5), a subject of concern among (6), health administrators and consumer (7).
For example, in the (8), the rate of Caesarean Section in 2006-7 was 24.3%, and this
was almost (9) from the previous year. In fact, an estimated (10) of deliveries were
‘not normal’, meaning that they involved surgical (11), use of instruments, induction,
epidural, spinal anaesthetic or (12) anaesthetic. Of patients having a Caesarean
Section, about (13) spent 4 days or more in hospital (14) from the procedure in 2006-
7, (15) from the figure of one third in 2005-6.

16

17

18

19

20

21

22

23

24

25

26

27

Reasons for the (16) CS rates include its routine use in (17) deliveries, the threat of
(18) leading to doctors intervening earlier in labour, and better survival prospects for
(19) preterm infants. The Australian figures, reported in the (20) Australia, are well
above the target rate of (21) set by the US Department of Health and Human Services,
but well below the 46% recorded (22). Controversy remains, however, and the (23)
National Institutes of Health states that (24) ‘ideal rate’ should be set for Caesarean
Section, as there are variables such as medical and health (25) and maternal
preferences, as well as the need to (26) the best maternal and (27) outcomes.

Summary Text Reading Part A Caesarean Section rates

Caesarean section is a surgical procedure to deliver a baby or babies by an

abdominal incision, also known as laparotomy, and a hysterotomy (an incision
through the uterus). It has traditionally been done when the life or health of the
mother or baby is at risk, but is now being done more often, a subject of concern
among obstetricians, health administrators and consumer groups.

For example, in the United Kingdom, the rate of Caesarean Section in 2006-7 was
24.3%, and this was almost unchanged from the previous year. In fact, an estimated
48% of deliveries were ‘not normal’, meaning that they involved surgical
intervention, use of instruments, induction, epidural, spinal anaesthetic or general
anaesthetic. Of patients having a Caesarean Section, about one quarter spent 4 days
or more in hospital recovering from the procedure in 2006-7, down from the figure
of one third in 2005-6.
Reasons for the high CS rates include its routine use in breech deliveries, the threat
of litigation leading to doctors intervening earlier in labour, and better survival
prospects for very preterm infants. The Australian figures, reported in the Medical
Journal of Australia, are well above the target rate of 15% set by the US Department
of Health and Human Services, but well below the 46% recorded in China.
Controversy remains, however, and the US National Institutes of Health states that no
‘ideal rate’ should be set for Caesarean Section, as there are variables such as medical
and health resources and maternal preferences, as well as the need to maximise the
best maternal and neonatal outcomes.