Ireland needs plan to reverse rising trend in Caesarean sections

The relentless rise in the popularity of Caesarean sections in recent years has been the subject of much handwringing.

As with our low breastfeeding rates, this generally takes the form of pious fretting about the trend and non-specific calls for something to be done.

And yet the graph continues upward as ever more women march – or are marched on the advice of their doctors – into the operating theatre for delivery, rather than giving birth naturally.

Overall, this is a bad thing. A Caesarean is an operation; it carries all the risk attending on any operation – bleeding, infection, adhesions, clots, etc. Recovery takes longer. Breastfeeding is harder. It costs more.

Asthma and obesity

Babies born by Caesarean section are more likely to develop asthma in childhood and to become overweight. Once a mother has one child delivered this way, it is overwhelmingly likely her other children will be delivered via Caesarean.

Certainly, there are risks attached to normal, vaginal deliveries. There are times when complications arise in a previously straightforward pregnancy and a Caesarean becomes necessary. However, for most women there should be no need to resort to the operating theatre to complete what is a natural process.

More research is being done into the reasons for the fourfold increase in the rate of Caesareans in the last 30 years. Caesareans are safer than ever and many lives – of mothers and babies – have been saved through having an alternative to normal delivery.

Age of mother

This doesn’t explain the full extent of the increase. Another major reason is the changing profile of mothers. As this study shows, one-third of mothers giving birth are now aged over 35 years. Another study found an increase of over 40 per cent in just four years in the number of obese mothers at one Dublin maternity hospital.

Older mothers, and obese mothers, are more likely to have pre-existing health conditions that increase risk at delivery. High blood pressure, gestational diabetes and miscarriage are more common. Scheduling Caesareans at the right moment during pregnancy may offer the best chance of minimising risk.

Even after safety, age and weight issues are considered, there are other factors behind the trend toward C-sections. One Irish study found private patients were twice as likely to have pre-planned sections as women whose treatment was publicly funded. Other research has pointed to the day of the week as a somewhat unlikely factor influencing rates of inducing labour.

Meanwhile, huge variations persist in the Caesarean rates found in each of the State’s 19 maternity units. In general, the rates are lowest in the bigger units and highest in some of the smallest ones.

Medical injury cases

This suggests smaller units, with less specialist expertise and back-up, are more nervous about the legal risks of delivering women naturally where complications arise. You only have to look at recent reporting of medical injury cases to see why.

Up to one-fifth of Caesareans are elective rather than emergency procedures. Often, this arises due to the woman having had a previous section or the baby being in a breech position. Pure elective Caesareans that are not medically indicated also occur though there is, curiously, little enough information about the size of the “too posh to push” brigade.

What is missing from the debate is a meaningful plan to reverse current trends, one that takes account of long-term challenges such as obesity, women’s preferences for their labour and the culture of defensive medicine that Irish doctors are forced to practise in a litigious culture.