The case in summary A review of emergency caesarean sections in Lofoten shows that there was no basis for performing 6 out of 15 of them. The birthing center in Gravdal in Lofoten is the only one in Norway prepared to perform emergency caesareans. Department director Geir Tollåli at Helse Nord expresses concern for patient safety and the quality of health services in Lofoten. Several areas with potential for improvement are pointed out, including how the delivery room selects which women can give birth in Lofoten. Nordlandssykehuset asks Helse Nord to make a new assessment of the current organization of maternity services. The hospital has introduced a number of measures following the review of emergency caesarean sections. The summary is made by an AI service from OpenAI. The content is quality assured by news’s journalists before publication. At Gravdal in Lofoten is Norway’s most unique birthing room. As the only one in the country, the delivery room has extra readiness to be able to perform emergency caesareans, so-called emergency caesareans. It can happen if complications arise during the birth. Emergency preparedness in the weather-resistant region is intended to keep the population safe, in the event of an accident. It was the rescue for Silje Andreassen in Lofoten, not just once, but twice. – It was life-changing. They saved my life and the children’s. Lofoten’s geography and weather conditions are the reason why they are the only delivery room in the country prepared to carry out emergency caesareans. Photo: Trude Furuly / news The first time was in 2012, when she became pregnant with her daughter. – One morning I had a lot of pain in my stomach and back and realized that something was wrong. The placenta had detached from the uterine wall before the child was born. The condition can be life-threatening for both mother and child. She was sent in an ambulance from Svolvær to Gravdal. Once at the hospital in Gravdal, it became clear that an emergency caesarean section was necessary. She has previously told her story to Lofotposten. Ten years after the births, Andreassen is happy that the local hospital was prepared for emergency caesareans when the placenta became detached during both pregnancies. Photo: Trude Furuly / news One more time The following year, when she was pregnant with her son Jakob, it happened again. Andreassen was then in her 27th week of pregnancy. The doctors wanted to send her by air ambulance to Tromsø, but they never got that far. – While the doctor was calling Tromsø to have me sent on, the baby’s heart rate dropped dramatically. Then the alarm was raised and there was an emergency caesarean section again, says Andreassen. She proudly boasts that the delivery room at the hospital in Gravdal had just this preparedness. – You never know when the emergency will arise, regardless of whether it concerns pregnancy or other illnesses, says Andreassen. The delivery room in Lofoten is unique in Norway, as the only one with emergency caesarean sections. Photo: Tommy Johansen “No basis” for six emergency caesareans But not all the emergency caesareans in Lofoten in recent years should have been carried out. It shows a review that Nordlandssykehuset itself has carried out of all 15 caesarean sections performed from 2019 until April 2024. news has been given access to a cover letter to the review which summarizes the findings. The review was carried out after a small increase in emergency caesarean sections performed at the hospital was registered. Here, a group of professionals looked at why these were carried out – and whether the national recommendations for which women should give birth in a delivery room have been met. – It showed that in 40 per cent of the cases (6 pcs.) there was no reason to perform an emergency caesarean section. That’s what specialist director Geir Tollåli at Helse Nord says. Geir Tollåli is specialist director at Helse Nord. Photo: Kai Jæger Kristoffersen / news – Is it serious? – Yes, you have to learn from these numbers. Experienced professionals, both midwives and gynecologists, have believed that these caesarean sections were not necessary then and there. It was Lofotposten that first mentioned the increase. – As it is a unique arrangement for Lofoten, we must have a special eye on patient safety and the quality of the healthcare services we deliver. – Do women giving birth in Lofoten have reason to be concerned? – No, by no means. But we must ensure that we follow the national guidelines that the directorate has given us. Selection criteria for birth in the delivery room: healthy pregnant women with a normal pregnancy and with an expected normal birth in the head position have followed the basic program in prenatal care no known diseases or conditions in the mother or fetus/child that give an increased risk of complications for multiple births: previous normal pregnancies and births the birth begins spontaneously with fetus in head position between completed weeks of pregnancy 37+0 and 41+6 SF measure within the normal range pregravid BMI 18.5–30 for first-time mothers, 18.5–35 for multiple-time mothers age 20–37 years The list is not exhaustive, and midwives/ a doctor should make a comprehensive individual assessment of the pregnancy. The delivery room is an offer for women in labor who meet the selection criteria and want to give birth there. Source: Directorate of Health The hospital in Gravdal in Lofoten has a birthing room, and can only accept women in labor who meet given requirements set by the health authorities. Midwife leader: – A goal of as few caesarean sections as possible – Even if we are really only going to have “green ladies”, i.e. the completely healthy ones with us, things can happen along the way, says midwife Nina Jamissen. She is the manager of midwives and child nurses at Nordlandssykehuset in Bodø, Lofoten and Vesterålen. Nordlandssykehuset has three places of birth in the health institution. In Bodø (women’s clinic), at Stokmarknes in Vesterålen (maternity ward) and at Gravdal in Lofoten (maternity room). Jamissen says that they follow the guidelines for who can give birth in the delivery room at Gravdal. – It is a goal for us to give the women the absolute best follow-up we can in a delivery room. Therefore, it is also a goal for us that we should have as few emergency caesarean sections as possible, says Jamissen. Jamissen says that every other month they report on each individual birth to Helse Nord. Nina Jamissen is head of midwives and child nurses at Nordlandssykehuset in Bodø, Lofoten and Vesterålen. Photo: Lise Forfang Hagen – We go through all births that happen in the delivery room once a month. We also carefully review the selections made in the same period, with a particular focus on those who are transferred at birth, says Jamissen. The review revealed several areas for improvement for caesarean sections in Lofoten, and the hospital has now introduced a number of measures: The measures from Nordlandssykehuset Photo: Tommy Johansen Once the woman in labor has been selected for a higher level of care, this should not be repeated. If there is doubt about the level of care, the woman giving birth must be selected to a higher level. In case of early suspicion of slow progress, the gynecologist must carry out an ultrasound to verify the position of the child. In case of emergency caesarean section, CTG registration must be continued until delivery. It must describe what is being done and why. It must also be described whether transfer to a higher level of care has been discussed and what assessments have been made. The setting of the child’s head must always be documented. Asks Helse Nord for a new assessment The maternity services in Lofoten have been under pressure after Helse Nord initiated a major restructuring process in 2023. In January this year, the then Minister of Health Ingvild Kjerkol (Ap) protected the maternity services in Lofoten, given proper operation. The then Minister of Health Ingvild Kjerkol (Ap) visited the hospital at Gravdal in December 2023. A month later, the maternity services were protected from cuts in Helse Nord, given that operations were at a reasonable level. Photo: Vilde Bratland Erikstad / news In the report news has obtained access to, it is stated that Nordlandssykehuset “considers that the current organization of the delivery service is not unreasonable.” Nevertheless, they ask Helse Nord to make a new assessment of the current organisation. Published 11.10.2024, at 21.37
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An increase in unnecessary emergency caesarean sections in Lofoten is causing concern at Helse Nord – news Nordland
