Doctors alarmed by steep rise in Caesarean births

DOCTORS AND childbirth experts are expressing alarm at the rapid rise in the proportion of Caesarean births to "unacceptable levels".

Almost one baby in three is now delivered by Caesarean section in some maternity units, and the rate is rising at 1 per cent a year. A Caesarean is a serious abdominal operation and studies show that women take longer to recover and are less likely to breastfeed if they give birth this way.

Fear of litigation, technological advances and a lack of support for women in labour are said to be behind the rise. But obstetricians claim it is also being driven by demand from women who want to guarantee a safe birth.

The 1998-99 survey by the English National Board for Nursing, Health Visiting and Midwifery found a quarter of maternity units had Caesarean rates of 20 to 30 per cent, compared with less than 10 per cent two years earlier. One in 50 maternity units had a rate above 30 per cent.

The World Health Organisation recommends that the acceptable rate for Caesareans in developed countries is 10 to 15 per cent. The sharp rise is to be discussed at a conference in London tomorrow, organised by the National Childbirth Trust. Belinda Phipps, its chief executive, said: "We are not asking for all Caesareans to be stopped. We know that in many cases they are necessary for good clinical reasons. However, in our view rates have reached unacceptable levels and we want to know why."

In Cornwall, the Caesarean rate was 13 per cent while in Surrey it was 26 per cent. "In our view that implies very strongly that the clinical advice given in Cornwall is different from that given in Surrey," Ms Phipps said. "I find it disturbing that in today's NHS women are advised to undergo extensive abdominal surgery for no clinical reason."

Professor James Drife, spokesman for the Royal College of Obstetricians, said the rise was being driven by fear - on the part of patients as much as professionals. If there is a mild abnormality on the foetal monitor women are not willing to take a chance, he said.

"I, as an obstetrician, can go and say I am 99 per cent sure that [the abnormality] is benign, but the woman says she is not prepared to take that 1 per cent risk. All the parties involved are unwilling to look at very small risks. Patient advocacy groups will say that's slanderous but it is very much my perception." The college is carrying out an audit of Caesareans at the request of the Department of Health, which will be published next year.

Professor Drife said: "We are concerned that something is happening that we don't entirely understand and we need to discuss it within the college and with other interested groups."

His view is challenged by Professor Lesley Page, head of midwifery at Queen Charlotte's Hospital, west London. "I don't accept that the rise is being driven by women. There is a slight increase in demand but in general most women given good support don't choose a Caesarean. Our threshold for doing them is lower because they are safer, because of the threat of litigation and because there is too much foetal monitoring and women are not attended enough in labour."

Frances Day-Stirk, head of midwifery affairs at the Royal College of Midwives, said: "As with any major operation Caesareans carry definite risks. To justify taking those risks there have to be positive clinical benefits to mother and child. In some maternity units the normal delivery rate is as low as 52 per cent. And giving birth is a normal physiological process."