Hospital consultant says Caesarean rates ‘almost a national crisis’

Caesarean rates in Ireland are "far too high," one of the country's foremost obstetricians has said.

Dr Declan Keane, a former master of the National Maternity Hospital in Holles Street and currently an obstetrician there, described it as "almost a national crisis".

He said his own hospital had a Caesarean rate of about 20 per cent, which he believed was too high, yet it was one of in the lowest in the country.

The highest rate is at St Luke's Hospital in Kilkenny, at 38 per cent. "We need to know why Kilkenny has a rate that is almost twice that of the rest of the country," he said.

'Flippant'
Dr Keane said he had been jokingly told by a consultant at the hospital that the high rate was to prevent future Kilkenny hurlers getting shoulder dystocia. He described that response as "flippant".

Dr Keane told the Home Birth Association of Ireland annual conference that home birth was as safe for low-risk women as a hospital birth, but many in the medical profession “tended not to listen”.

Some regarded home birth as like “riding a motorcycle without a helmet”.

He described giving birth in Ireland as an “over-hospitalised process”, saying deliveries should be left to midwives, with doctors only intervening in an emergency.

He also believed there were some obstetricians in private practice who regarded other forms of obstetric care as a threat. “Consultants should stop looking at this as a threat to their private practice. There is more than enough to go round.”

Dr Keane was master in Holles Street when the Domino scheme was introduced in 1998 which allowed women to give birth at home or in a midwife-led centre.

Domino scheme
Some 479 babies have been born through the scheme. Dr Keane said there had not been a single adverse outcome to any of those births and no child born through it had to be transferred to hospital.

Dr Amali Lokugamage, a consultant obstetrician based in the UK, told the conference medical students were often so "immersed in the education of pathology" that they did not see birth as a natural process.

Medical students had little exposure during their education to normal birth and were instead immersed in what could go wrong, she said.

Many obstetricians, midwives and other medical personnel involved in critical incidents could suffer from a form of post-traumatic stress which could negatively affect the way birth was presented.

Dr Lokugamage said women who had a home birth regarded their birth experience as "universally positive" even if some had to be taken to hospital due to complications before delivery.

Studies had shown that women who had given birth at home felt positively about what they had done, she said.