Page last updated at 20:01 GMT, Tuesday, 27 October 2009

Emergency c-sections predominate

Pregnany woman
Many women end up having an emergency caesarean

Emergency Caesarean rates continue to outstrip planned operations, official NHS statistics for England show.

The country's overall Caesarean rate has remained static at nearly a quarter of all births, but there are significant regional variations.

Babies at Chelsea and Westminster NHS Trust are twice as likely to be born by Caesarean as those in Nottingham.

But the mantra of "too posh to push" does not reflect the many Caesareans carried out amid labour complications.

There were nearly 155,000 Caesareans recorded between 2008 and 2009. Nearly 10% of all births were carried out by an elective procedure, but nearly 15% were unplanned operations, this year's figures from the NHS Information Centre show.

London trusts had the highest rates of emergency caesareans.

Controversial issue

Over a fifth of babies born at Newham University Hospitals NHS Trust were born in this way, while planned operations - at 7.3% of all births - were below national rates.

The lowest rate of emergency Caesareans was seen at Wrightington, Wigan and Leigh NHS Foundation Trust, at 9%, while Peterborough and Stamford NHS Foundation Trust saw the lowest rate of elective operations, at just 5.6% of all births.

The high rate of Caesareans remains a controversial issue in the UK.

It is disappointing that we are not seeing a drop in the Caesarean section rate, and worrying that there are such wide regional variations
The Royal College of Midwives

Under guidelines from the National Institute for Clinical Excellence, women have no automatic right to an elective Caesarean, and should be offered counselling if in fear of childbirth.

But a number of prominent doctors argue that it should be up to a women to choose her mode of childbirth after being appraised of the risks and benefits. While babies born by Caesarean are more likely to have respiratory problems, there is no increase in mortality.

For the mother, she is at risk of further surgery, for instance, but less likely to develop urinary incontinence or suffer a prolapse.

It has been suggested that some emergency Caesareans could be avoided by improved training of junior doctors in carrying out instrumental births - using forceps or a ventouse to help deliver the baby when the second stage of labour is prolonged.


But the rate of emergency sections is also linked to the socio-economic groups of patients and related health problems. Obesity, for instance, increases the chances of Caesarean.

Chief executive of the NHS Information Centre, Tim Straughan, said some hospitals would need to examine closely the full range of reasons why their rate was different from the national average.

Chelsea and Westminster Hospital said in a statement that all of its Caesareans had been carried out for "clinical" reasons.

Newnham University Hospital NHS Trust said it had completed an audit and had developed specific actions.

Cathy Warwick, general secretary of the Royal College of Midwives, said the findings were worrying.

"It is disappointing that we are not seeing a drop in the Caesarean section rate, and worrying that there are such wide regional variations, given that there is general agreement that Caesarean section rates are higher than they need to be.

"This is a major operation, with potential complications for women and their babies."

The National Childbirth Trust said the figures suggested the situation was getting worse, with "high Caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them."

Normalising birth

Pauline McDonagh Hull of, a website on birthing choices, said women were not being told in antenatal classes how many vaginal deliveries run into complications and end up being emergency Caesareans.

"Personally, I would rather have elective surgery than emergency surgery and the risks that carries," she said.

But a Department of Health (DH) spokesperson said its policy on Caesareans was in line with guidelines laid down by the National Institute for Health and Clinical Excellence.

The spokesperson said elective Caesarean sections are only performed if there is clinical evidence of expected benefits of these to the mother and/or baby.

A consultant also has to be involved in the decision to undertake any Caesarean.

"DH is focused on improving support for women with the aim of normalising birth and reducing the number of Caesarean sections needed or wanted, for medical or emotional reasons," said the spokesperson.

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