The presentation of a study showing Caesarean sections are more common among pregnant women who have private insurance and who attend consultant obstetricians as private patients, raises some important issues. The authors suggest that many women may be undergoing unnecessary Caesareans, with attendant health risks for both mother and baby. The researchers surveyed 11,000 women, almost 27 per cent of whom had sections. Of these, 52 per cent were emergency procedures while 48 per cent were planned. Reasons for planned Caesareans include twin pregnancies and high maternal blood pressure. Emergency sections may be needed when the baby shows signs of distress during birth or if the mother experiences placental problems in the latter part of pregnancy.
Caesarean section rates have been rising in the Republic: at 26.7 per cent, the Irish rate is higher than the UK rate (23 per cent) and the European average of 19 per cent. However this latest study found that women attending a private consultant alone were 74 per cent more likely to have a section than those receiving shared care from a GP and public maternity hospital. And while the researchers presented evidence questioning the anecdotal “too posh to push” phenomenon, such a large discrepancy is unlikely to be due to physiological differences between women of different means.
Reasons cited for the rise in Caesarean section rates include more older women having babies, better detection of foetal distress and the late presentation of some pregnant women. However, a rising fear of litigation, doctor convenience and financial incentives have been suggested as alternative explanations. The study authors made allowances for pregnancy complications and maternal age, resulting in the conclusion that “the increase in C-sections often occurs in the absence of obstetrical or serious maternal complications”. Which prompts an important question: are pregnant Irish women receiving a different standard of obstetric care based on their ability to pay?