A few days ago I was privileged to attend a lecture at Dunedin Public Hospital presented by Mike Robson, Master of the National Maternity Hospital in Dublin, Ireland. Most health professionals involved in maternity care have thoughts about the rate of caesarean section delivery. We often argue and debate what is the right rate. The obstetric argument is often that caesarean's are not done unnecessarily and therefore the rate must be right, whatever it is. Mike suggested that we should be concerned with what the consequences are of our high rate of operative delivery. He presented the list of complications that can arise from caesarean section(a long list) the list of things which are unchanged by having a caesarean section (much smaller) and the things which are improved by having a caesarean section (only three things). These lists are available on page 19 of the Caesarean section guideline from NICE UK web site . A message for all of us is that, in order to understand what the effects are of treatments that we offer, we need to keep reliable and consistent statistics. High numbers of babies being born by caeserean section is a relatively new phenomenon and we cannot know what impact this will have in the future.
A major concern, from his statistics, was that most women 'requesting' caesarean section are women who have birthed before. We clearly need to do better with supporting women having their first babies. I wonder if these statistics can be broken down at all, to show us if there is any particular thing that contributes to these women requesting caesarean. For example do women who have planned a homebirth fall into this category more or less often? Do women who have planned waterbirth? Do women who have had an epidural? Whatever the case, this is something that lies firmly in the hands of midwives. We need to take responsibility for this statistic and we can do something to improve it.