WOMEN WHO opt for repeat Caesarean sections when giving birth are at increased risk of requiring a Caesarean hysterectomy, a leading obstetrician has warned.
Prof Michael Turner of the UCD Centre for Human Reproduction at the Coombe Women and Infants University Hospital said women needed to be aware of this risk when considering how their baby would be delivered.
“A Caesarean section is a surgical intervention that has made a major contribution to improving the outcome of pregnancy for mothers and their babies and in many cases it is the best option for the mother and her baby. The decision, however, must always be carefully considered. In some cases, a Caesarean section may not be necessary to achieve a good outcome,” he said.
When a decision is made to deliver a baby by Caesarean section short-term considerations usually dominate, he said. “Obstetricians, however, also have a responsibility to take a woman’s long-term reproductive outcomes into consideration when they are considering primary Caesarean delivery especially in the absence of sound medical indications.”
His comments, in a paper published in the International Journal of Gynaecology and Obstetrics, follow the publication of a study last year which showed the overall Caesarean delivery rate across the three Dublin maternity hospitals rose from 6 per cent to 19 per cent over the four decades between 1966 and 2005, a period during which over 872,000 deliveries occurred. In 2007, the national Caesarean section rate had risen to 26.2 per cent.
Prof Turner said because Caesarean sections have become so easy and safe to do, he believes they are probably done too often. “One in four Irish women are now having babies by Caesarean section. In America it’s one in three . . . in my opinion it’s too high.
“There is too much short termism . . . there are parallels with the economy over the last decade where people lived in the moment and they went for the easy, soft, short-term options without giving consideration to the long-term implications of today’s decisions.
“It’s only natural when a woman is pregnant she is only concerned about this pregnancy, but for women considering having more children they have to be thinking of the next baby and the one after that,” he said.
“Sometimes the Caesarean section is the right thing to do, but it shouldn’t be done solely for social reasons or for convenience because if you have a Caesarean section in this pregnancy you are more likely to have one in future pregnancies and the more, Caesarean sections a woman has the more likely it is she is going to need a Caesarean hysterectomy,” he said.
Internationally he said the incidence of Caesarean hysterectomy is one in 1,000 births. In the Coombe it is one in 5,000.
“My concern is that the increasing number of Caesarean sections that are being done is going to lead to an increase in the number of Caesarean hysterectomies in the future . . . preliminary data from this hospital would indicate the number of Caesarean hysterectomies for placenta bed pathology [where the placenta becomes too adherent to the wall of the uterus or may even go through the wall of the uterus] is increasing,” he said.
The more Caesarean sections a woman had the more likely she is to have complications with the placenta, he added.
“In women who had previous vaginal deliveries and no problem with a placenta, it’s exceptionally rare for them to need a hysterectomy in this hospital and I suspect in this country”.
He acknowledged fear of litigation could be a factor in obstetricians doing more Caesarean sections, but he said that in general, about half of women who have had just one Caesarean section could deliver a baby safely vaginally next time around. But knowing which half is “quite a challenge”.
