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Last Updated: Wednesday, 18 June, 2003, 08:54 GMT 09:54 UK
Caesarean crack-down urged
One in five births are now by caesarean
MPs have called for a crack-down on the number of women having Caesarean births on the NHS.

A report by the influential Commons health committee says pregnant women should no longer be able to choose to have a Caesarean.

It says doctors should only deliver babies in this way "when medically or psychologically necessary".

MPs suggested that in many cases Caesarean births are a waste of NHS resources and an unnecessary risk to mothers and their babies.

High rates

Figures suggest that almost one in four births in the UK is now delivered by Caesarean section.

This is well above the 10% rates recommended by the World Health Organization.

Without adequate staffing levels, choice for women can be restricted
Professor Bill Dunlop,
Royal College of Obstetricians and Gynaecologists

The government has pledged to reduce the figure. Caesareans carry a small but increased risk for women and their babies compared to natural births.

However, they are also more expensive. A Caesarean birth costs the NHS in the region of 760 more than a natural birth.

The National Institute for Clinical Excellence is drawing up new guidelines for doctors, which will advise them on when they can carry out Caesareans. These guidelines are due out early next year.

However, Caesareans remain popular with many women not least because it offers them a relatively fast delivery.

The committee's report identified huge variations in the proportion of births delivered by Caesarean across England, ranging from 11% at the Royal Shrewsbury Hospital to 30% at St Mary's Hospital in Paddington.

MPs said action was needed to tackle these variations. They suggested the first step should be to stop women from choosing to have a Caesarean for lifestyle reasons.

It states: "The NHS does not generally provide other major operations for patients when there is no clinical need, nor does the NHS tend to offer choices of treatment to patients when one costs on average 760 more per patient than the alternative, since it is obliged to make the best use of NHS resources.

"We would like to see a distinct shift in emphasis to ensure that elective Caesareans as a 'lifestyle choice' are not supported by the NHS and that Caesarean section should be a procedure undertaken only when medically or psychologically necessary and after appropriate support and counselling."

MPs also called for consultants to publish their Caesarean rates. They said the move would enable women to compare the performance of individual doctors.

"Although we recognise the sensitivity of releasing individual consultant data, we believe this data should be given to all users together with national and local comparisons so that woman are aware of their consultant's Caesarean section rate," the MPs said.

Staff shortages

Professor Bill Dunlop, president of the Royal College of Obstetricians and Gynaecologists, welcomed the report.

He said guidelines from the college and the National Institute for Clinical Excellence would help to reduce Caesarean rates.

However, he suggested that staff shortages are also contributing to the current problem.

"The implementation of all these guidelines will go some way to ensuring that medical intervention in labour and childbirth only occurs when necessary.

"But guidelines alone will not solve the problem of a high Caesarean section rate. One-to-one care for women in labour is equally important, yet we are facing a staffing crisis in both midwifery and obstetrics.

"Without adequate staffing levels, choice for women can be restricted. Urgent action is required to address these issues."

Liberal Democrat MP Sandra Gidley, who is a member of the Commons health committee, added: "The government must tackle some of the appalling staff shortages.

"I fear that overworked midwives may vote with their feet and leave, thus putting a greater pressure on maternity services."

Frances Day-Stirk of the Royal College of Midwives said the increase in caesareans was partly down to concern among doctors and midwives that they may face legal action if something goes wrong with a natural birth.

"For the last 30 years, both doctors and midwives have worked in an environment that is increasingly litigious and I think it does have some bearing on how we practise today.

"The challenge for midwives is to make sure that our education is properly equipping midwives to facilitate natural birth as far as possible, so women know if they are advised to have a caesarean, it really is for some valid clinical reason and not simply as a precautionary measure," she told the BBC.

Commons health committee member Julia Drown
'It is a very frustrating situation for midwives'

Maternity care praised
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