Midwifery expert: Women should be informed of caesarean section risks

Women should be made more aware of potential health complications arising from caesarean sections before undergoing the operation, a leading midwifery expert has said.

In the wake of an Economic and Social Research Institute (ESRI) report released on Tuesday showing that caesarean section rates are soaring in Ireland compared to previous decades, Professor Cecily Begley outlined increased risks of wound pain and emergency room visits for women who have the procedure.

According to the Maternal Health and Maternal Morbidity in Ireland (MAMMI), a study overseen by Prof Begley which surveyed 2,800 first-time mothers across Ireland, more than half of those who were sectioned suffered wound pain in the three months immediately after birth.

Instances of post-birth wound infection, wound breakdown and wound repair were all more common among women who had a caesarean section compared to those who had a natural birth, with emergency sections posing a particular risk of perinatal complications for the mother.

Those who had a caesarean section were also more likely to require repeat trips to a GP, to visit an emergency department or to be readmitted to a hospital than those who underwent natural births.

Prof Begley, who carried out the research in association with colleagues from Trinity College and the Health Research Board, said women should be informed of problems that can come about from the operation, saying that "as far as possible we should avoid the first caesarean section".

On the increase in caesarean section rates, Prof Richard Layte said he expects the rate will continue to rise over coming years in line with Ireland's ageing population demographic and a desire among women to have children later in life.

Addressing an ESRI conference on the topic, he said more risk-averse practices in hospitals are contributing to the trend as physicians perceive they have more control in cases of caesarean sections than natural births, thereby reducing the potential for malpractice litigation.

He confirmed that although there are variations in caesarean section rates across Irish maternity hospitals, with smaller regional units more inclined to carry out the operation than dedicated maternity hospitals, rates have begun to even out somewhat in recent years.

Further analysis of the findings, which encompassed a period of 17 years, showed that women of west African origin are more likely to be sectioned due to a higher rate of obesity among the group, while patients from the UK, mainland and eastern Europe are less likely to rely on that method of delivery.

Figures from the MAMMI study demonstrate a higher reliance on caesarean sections among overweight and obese women, whereas those of a normal weight tend to opt for the natural route.

Meanwhile, former master of the Coombe Hospital Prof Michael Turner criticised "unnecessary scaremongering" from the media and politicians regarding methods of delivery, and said "knee-jerk" reactions to certain adverse outcomes in maternity hospitals are not helpful.

"This kind of culture where people, politically, want to get a midwife's head on a plate, report the midwife to Bórd Altranais, or the obstetrician's head on a plate or to report them to the Medical Council, that's the wrong approach and I think it may be counterproductive in driving operative interventions," he said.