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Wide variation in Caesarean rates in UK

8th October 2010

Differences in opinion between doctors has been highlighted as the cause of varying rates of Caesarean sections across England.

Baby Ward

Experts studied more than 62,000 births at 146 trusts and found that the number of women undergoing the procedure ranged between 13.6% and 31.9%.

In the study published in the British Medical Journal, experts say their research identified a need for “informed surveillance” of why there are such differences.

Researchers from the Royal College of Obstetricians and Gynaecologists analysed births among women aged between 15 and 44 during 2008 and found of 620,604 births, 24% were delivered by Caesarean section.

A high proportion of women underwent the procedure because they had previously experienced a Caesarean (71%), a breech baby (90%), or serious medical complications (85%).

But experts said results did not support suggestions that increasing numbers of women are opting for Caesareans for non-medical reasons.

They now want trusts to examine the reasons for the variation.

Mervi Jokinen from the Royal College of Midwives (RCM) said her organisation was pleased to see that the findings refuted the view that "it is women requesting Caesareans who are pushing up the rates".

A Department of Health spokesman said: “Requests for Caesarean sections should be managed in accordance with the National Institute for Health and Clinical Excellence guideline recommendation that all clinical interventions, including elective Caesarean section, are only performed if there is clinical evidence of expected benefits to the mother or baby. A consultant must be involved in the decision to undertake any Caesarean.”

 

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Comments

Pauline Hull

Saturday 9th October 2010 @ 16:26

The idea that this study provides categorical evidence about whether, or indeed how many, women are requesting caesarean births is flawed.

The authors write: “It seems unlikely that maternal request in the absence of any clinical indication contributes substantially to the rates.” This is not the same as saying that maternal request is not contributing to the rates ‘at all’ or that women choosing caesareans is a myth. As far as I am aware, no media report as yet has actually cited the number (or percentage) of non-medically indicated caesareans found in this study, and I have contacted the authors for further clarification of this precise figure.

As it stands, the current estimate of rates of caesarean delivery on maternal request is around 5% of all births. This is clearly a very small number. However, it is more than double the number of women who request a homebirth, and yet these women and their birth choice are afforded greater support and respect by many birth support groups and the Department of Health.

As a final point, here are some other reasons why this study (which analysed routinely collected hospital episode statistics and did not involve any interviews with women or doctors) does not provide categorical proof that women are not choosing caesareans themselves or that caesareans in the absence of any clinical indication are not contributing to overall caesarean rates:

1) A medical indication and maternal request are not mutually exclusive. Anecdotally, I chose to plan a caesarean for both my births but my hospital data reads ‘breech presentation’ for the 1st (as this was discovered in the 8th month of pregnancy) and ‘repeat caesarean’ for the 2nd. I have also been contacted by other women via my website whose situation is the same.

2) It is not unknown for a medical indication to be cited by doctors on a woman’s records rather than draw attention to the more controversial indication of maternal request.

Please note that this comment is not in any way a criticism of the study itself or its authors; only the wider interpretation of maternal request caesareans that is being reported. In fact, the study itself presents extremely useful data and suggestions for NHS trusts going forward.


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