Consultants linked to increase in C-sections

CHANGES IN the way consultants treat women due to give birth may be a significant factor in the rise of the Caesarean section rate in Ireland, a new study suggests.

In looking at the 25 per cent rise in the rate of Caesarean sections between 1999 and 2006, Economic and Social Research Institute (ESRI) research found that only half the increase could be explained by known risk factors.

These include older women giving birth, the earlier gestational age of the child, the higher socio-economic status of the mother and birth within a private hospital.

In 1999, less than 20 per cent of births were by Caesarean section but by 2006 this had increased to more than 25 per cent, considerably higher than the maximum rate of 15 per cent recommended by the World Health Organisation.

While Ireland’s rate is one of the highest in Europe, only the Netherlands achieves a rate lower than 15 per cent.

Birth by Caesarean section increases the health risks for both mothers and babies, when compared with spontaneous vaginal birth. It is also significantly more expensive for the health service.

“The rate keeps going up and we need to find out why this is happening,” the co-author of the ESRI working paper, Aoife Brick, told The Irish Times yesterday.

Working with the available data concerning births in Ireland, they could explain about 50 per cent of the increase in Caesarean sections, she said. They analysed the data by adjusting for a large number of maternal, child and hospital factors.

However, there are limitations in the information recorded by the National Perinatal Reporting System (NPRS), she pointed out, the main one being that they could not identify if a Caesarean section had been an emergency or an elective procedure.

The research showed that, in common with the experience in other countries, women in Ireland were having fewer children and having them later in life, leading to a large increase in the proportion of women giving birth over the age of 35.

“The Caesarean rate has increased for mothers of all ages, but the highest rate of increase has been for mothers aged 35 or over, where rates have increased by almost 30 per cent,” the paper notes.

“This may be because of the clinical indicators for this group have worsened but it is likely that the high rate of increase reflects changing behaviour on the part of the mother and/or physician.”

International data does not support the popular notion that the rise in Caesarean sections is being driven by women “too posh to push”, at least in developed countries, Ms Brick said.

“We just put forward changes in consultant behaviour as a possible reason for the increasing trend, but as yet we don’t have anything to substantiate that,” she explained.

However, she pointed out that, internationally, this was suggested as a possible reason as well.

Stressing that the research is ongoing and not yet published, Ms Brick added that the working paper had been put up on the ERSI website to invite feedback from other academics and the medical profession.

• For more information, see www.ersi.ie