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Last Updated: Wednesday, 28 April, 2004, 01:18 GMT 02:18 UK
'How we cut Caesarean numbers'
By Caroline Ryan
BBC News Online health staff

St George's Hospital
The hospital changed the way it provided maternity care
Experts have issued guidance aimed at reducing the number of Caesareans carried out.

They say this can be done by encouraging women to consider having a natural birth - and by maternity units using tests and ways of supporting women which would reduce the need for surgery.

Women who have had a Caesarean before can find it easier to say they want another one
Dr Basky Thilaganathan
St George's Hospital in south London has already succeeded in cutting its Caesarean rate by almost a third.

In 2001, around 26% of babies born at the hospital were delivered by C-section. Last year, it was just 18%.

The achievement is all the more remarkable because St George's cares for women across the south east who have complex health problems such as heart conditions and who therefore cannot give birth naturally.

Tighter rules

Dr Basky Thilaganathan, consultant in foetal medicine at St George's said a number of changes including new consultants and a bid to move towards a service provided, rather than directed, by experienced doctors and nurses had forced them to re-evaluate the care they gave.

"We looked at emergency Caesareans, which made up around 16% of Caesarean sections.

"We found out we were inducting a lot of women. It's difficult to get women into labour, and the baby was often too tired, so we would end up having to carry out a Caesarean."

The hospital decided to tighten up its rules on when women should be induced. Instead of carrying out the procedure days after the woman's due date, they instituted a rule of waiting two weeks.

Dr Thilaganathan's team also changed the method they used to monitor babies' heartbeats to one which gave fewer "false positive" results, which led to unnecessary Caesareans.

He said the hospital had also been able to reduce the number of planned Caesareans carried out.

"Women who have had a Caesarean before can find it easier to say they want another one.

"But the evidence suggests that around 60 to 70% who go on to have a normal labour the second time around will deliver normally.

"So we changed our policy for monitoring women with previous Caesarean sections."

'Something to aim for'

He added women who were "too posh to push" were rare: "Some do ask to have a Caesarean. But my experience is that these women usually have got this idea from the media or from other women. It's usually an uninformed and naive concept.

"We explain to them clearly what the risks of major abdominal surgery are, and which they weren't aware of. They usually then say they don't want the operation."

Dr Thilaganathan said last year, only 10 Caesareans were carried out at St George's because the mother had requested one. The hospital carried out 900 Caesareans in all, 400 of them emergency procedures.

Two years earlier, a total of 1,100 were performed.

He said for the same to be achieved in other hospitals, both the resources available and the way of delivering care had to be right.

"Government guidelines are good because they give us a something to aim for.

"The problems are having the resources to do so and the teamwork to do it."

Caesareans 'must be discouraged'
28 Apr 04  |  Health
More women having natural births
01 Apr 04  |  Health

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