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Tuesday, 2 May, 2000, 09:42 GMT 10:42 UK
Crackdown on Caesarean boom

Fewer women are opting for traditional delivery
Expert checks are being carried out in an attempt to reduce the number of unneeded Caesarean deliveries.

During the three month audit of every maternity unit in England and Wales, doctors will be asked to justify each decision to give a Caesarean section.

The number of women having babies by Caesarean section has soared in recent years - it is estimated that one in five now gives birth this way.

But while it may be medically necessary to perform a Caesarean in certain circumstances, experts stress that it is a major operation and carries risks for both mother and child.

Women who undergo Caesareans also take longer to recover than those who give birth naturally. They may be more prone to bleeding, and even to infertility.

Research has also shown that babies born by Caesarean section tend to be at an increased risk for breathing difficulties than their vaginally born counterparts.

There are fears that many women are choosing to have Caesarean sections so that the time of delivery can be more accurately planned.

Some women also believe it is better to avoid a possibly prolonged labour, and the ongoing discomfort of damage caused by the birthing process by having a planned operation instead.

Every Caesarean section costs the NHS up to 1,000 more than a traditional delivery.

The Department of Health has provided the funding for the three-month audit, which is expected to cover at least 30,000 births.

First resort

There is evidence that a woman who has one-to-one contact with a midwife throughout her labour is far less likely to need a Caesarean section

Belinda Phipps, chief executive, National Childbirth Trust

There are also concerns that some doctors are resorting to Caesarean section for any birth that is not straightforward because they fear litigation should anything go wrong.

Certainly, there appear to be wide variations between hospitals in the proportion of women who give birth by Caesarean.

Belinda Phipps, the chief executive of the National Childbirth Trust, said that a shortage of midwives, often leaving inexperienced junior doctors making difficult decisions about whether to opt for Caesarean section, could be at the root of the problem.

She said: "It takes a lot of courage to do what a midwife does - that is watchful waiting during labour.

"A lot of hospitals have devices which monitor whether the baby is in distress - but they aren't very reliable, and a blood test is needed to confirm this, and many carry out Caesareans without doing this.

"There is evidence that a woman who has one-to-one contact with a midwife throughout her labour is far less likely to need a Caesarean section."

Planned Caesareans 'not common'

Planned Caesareans for convenience were not as common as widely thought, she said, stressing that women needed to be in possession of all the facts about the risks of both methods before choosing.

"At the moment we have a choice - but it's not a fully informed one."

The Royal College of Midwives said that in some parts of the country, as many as half of all deliveries were by Caesarean.

Department of Health figures showed that in Cornwall, just 13% of women had Caesarean sections, while in Surrey, the figure was twice that.

The World Health Organisation puts the acceptable rate of Caesarean sections at between 10% and 15% for countries in the developed world.

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See also:

20 Jul 99 | Health
Inquiry into Caesarian costs
28 Aug 99 | Health
The changing face of childbirth
22 Nov 99 | Health
Caesarian section 'too common'
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