Saturday, September 8, 2007

Caeserean section rates

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.

1 comment:

Sarah Stewart said...

Thanks for your reflections on cesarean section. As you say, we do not even know how many women request c/s-I would suggest that it is blurred ie obstetricians and midwives justify the c/s under a different category ie find another reason to do the c/s rather than maternal request. How many times have we seen that with induction of labor - we are not honest and say it is at the woman's request. But as someone once said to me, no where else in medicine do we carry out surgery at request unless it is paid for - would we chop off a woman's leg because she wanted us to? Yes, I know plastic surgery goes against my argument, but mostly it is paid for privately. On the other hand, would 100% c/s rate really be an issue? After some of the births I have seen, especially instrumental deliveries, it is hardly surprising women opt for a c/s second time around. What I am concerned about is, are we (midwives and doctors) losing our skills at 'managing' normal birth that actually, c/s is better than a mis-managed vaginal birth? Sorry about the word 'manage', I probably mean facilitate or some other word.

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