Pregnancy outcomes for women who have had five or more babies

Australian women giving birth after having had five or more babies (grand multiparity) do not have an increased risk of problems during the birth, according to a study in the latest issue of the Medical Journal of Australia.

Dr Michael Humphrey, Director of Obstetrics and Gynaecology at the King Edward Memorial Hospital, Perth, said that women with grand multiparity are being inappropriately classified as "high risk", leading them to receive inconvenient, costly and unnecessary interventions during labour.

His study of almost 16,000 women who gave birth at Cairns Base Hospital, Queensland, between 1992 and 2001 found that women with grand multiparity were significantly older than those with fewer previous babies, and significantly more likely to be Indigenous, to have had one or more previous caesarean sections, not to have received antenatal care and to have smoked during pregnancy.

When these factors were taken into account, women with grand multiparity who began labour (ie, did not have an elective caesarean section) were no more likely than those with fewer previous babies to have complications such as postpartum haemorrhage, blood transfusion or perinatal death. They were also twice as likely to have a spontaneous vaginal birth.

Dr Humphrey said this study does not support the traditional view that women with grand multiparity are more likely to have complicated deliveries, higher perinatal mortality rates and poor maternal outcomes.

"Women with grand multiparity do not have an increased likelihood of poor pregnancy outcomes," said Dr Humphrey.

"We need a prospective, randomised controlled trial that is large enough to reach an incontrovertible conclusion regarding the appropriate care of this group of women in labour", he concluded.

"Such studies may mean that we should revise birth-suite protocols that dictate interventions as routine during labour in these women."

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:                 Professor Michael Humphrey, 08 9340 1393
                               Business hours only.  No after hours number available.

                               Judith Tokley, AMA, 0408 824 306