Choice of hospital affects likelihood of Caesarean

Non-emergency (elective) Caesarean sections are highest in Kerry General Hospital, at 28 per cent, and Mount Carmel Hospital in Dublin, at 24 per cent, according to a new consumer guide to maternity services to be published later this month.

Cuidiú - the Irish Childbirth Trust - survey also found elective Caesarean section rates of 9 per cent in the Coombe Women's Hospital, 10 per cent in the National Maternity Hospital (NMH), Holles St, Dublin and 11 per cent in the Rotunda Hospital, Dublin.

The percentage of all mothers who give birth by Caesarean section varies between 18 per cent in the NMH to 37 per cent in Mount Carmel.

Commenting on the results, Declan Devane, lecturer in midwifery, school of nursing and midwifery, Trinity College Dublin, said: "The survey shows that where a woman gives birth makes a difference. And it is a cause of concern that in some hospitals, less than 50 per cent of all mothers will have a normal birth."

This is the second consumer guide to maternity services compiled by Cuidiú.

"The aim of the guide is to show that the choice of care-giver impacts on the type of birth a woman has," said Niamh Healy, an ante-natal teacher with Cuidiú.

The survey is based on results from a questionnaire sent by Cuidiú to all 23 maternity units in Ireland in December 2006.

To date, has received responses from 18 consultant led maternity units and two mid-wife led maternity units.

Analysis of the survey shows that women are twice as likely to have their babies by Caesarean section in some maternity units than in others. Mothers-to-be are also twice as likely to have labour induced in some maternity hospitals than in others.

Rates of induction vary hugely across maternity units with highest rates in Mount Carmel Hospital (29 per cent) and Limerick Regional Maternity Hospital (29 per cent) and the lowest rate of 15 per cent in Kilkenny General Hospital.

Induction rates for the three Dublin hospitals were reported as 19 per cent for the Rotunda, 24 per cent for the NMH and 26 per cent for the Coombe.

Most hospitals said that in normal pregnancy, induction is offered when a mother is ten days beyond her baby's due date.

Commenting on the high rates of Caesarean births and high rates of induction in Mount Carmel hospital, Dr Gerry Rafferty, consultant obstetrician at Mount Carmel said, "We have women who come to us who have had a difficult labour and operative style delivery (using forceps or ventouse) in one of the three Dublin maternity hospitals.

"They opt for a Caesarean section on a second or third baby. We will do a Caesarean section on request after appropriate counselling."

According to Dr Rafferty, women having their second, third or fourth babies will often ask that their baby be induced.

"In Mount Carmel, we adhere to best practice guidelines but we don't have specific induction policies which states consultants have to wait until ten days after the due date to induce a baby."

The use of epidurals for pain relief in labour also varied hugely between maternity hospitals, with 11 per cent of all mothers using epidural during labour in Letterkenny General Hospital and 21 per cent in Cavan General Hospital (one of the two mid-wife led maternity units) compared with 71 per cent of all mothers using epidural during labour in Portiuncula Hospital in Galway.