Push for action as Caesarean rate soars

• Caesarean section births in Scotland jump by 50% in the past decade

• Many women risk premature delivery to get their figures back quickly

• Critics say the rate is very worrying and urge action to curb numbers

Key quote

"While there are some good clinical reasons for people opting for a Caesarean, this dramatic increase shows many of these decisions are not being made on clinical grounds." - Shona Robison, the SNP health spokeswoman.

Story in full THE number of women in Scotland choosing a Caesarean section has jumped by nearly 50 per cent in a decade, new figures revealed yesterday.

The popularity of the operation, a common choice among celebrity mothers such as Victoria Beckham, Kate Winslet and Zoe Ball means that one in 12 women now chooses the method over natural childbirth.

The figure soars to one in four births when emergency Caesarean section operations are factored into the statistics released yesterday by the NHS in Scotland.

An extraordinary coalition from natural childbirth advocates right through to the Royal College of Obstetrics and Gynaecologists agree that the Caesarean rate is too high and the rate of increase is alarmingly steep - another couple of decades and most births could be by Caesarean.

Beverly Beech, from the Association of Improvement in Maternity Services, said: "The Caesarean rate in Scotland is a national disgrace."

However, the trend for women to request a Caesarean before the date their baby is due is a UK-wide phenomenon.

It is also mirrored in the USA, as well as other, less affluent countries including Brazil and Puerto Rico.

Some experts in obstetrics and gynaecology are alarmed that many women are opting for the operation in the belief it will be less painful than natural childbirth, and even help them regain their figure after the birth.

Photographs of celebrities emerging from hospital with their pre-pregnancy figures seemingly unchanged appear to have had more influence on pregnant women than realised before. According to an attitudes survey, also published yesterday, poor body image following childbirth is cited by more than 80 per cent of new mothers as the factor which took the joy out of having a baby.

The desire to "snap back into shape" is so strong among some women in the US that some now request a Caesarean section four or even six weeks before their due date.

They would rather have premature, underweight babies than risk stretchmarks or sagging breasts - a new level of selfishness that experts warn puts the health of their infants at serious risk.

The NHS National Services Scotland statistics published yesterday show 7.8 per cent of women elected to give birth by Caesarean section between 2000 and 2002, compared to 5.4 per cent in 1990-92. In the same period the number of emergency Caesareans rose to 14 per cent from 9.2 per cent.

The figures also show that the number of women of child-bearing age (15-44) has fallen by 3.8 per cent between 1990-2002.

The nation’s fertility rate has also fallen marginally in the last decade, with significant variations among NHS board areas.

The report found the general fertility rate has fallen from 58 live births per 1,000 women aged 15-44 (1990-92) to 48 per 1,000 (2000-02).

Dr Patrick Chien, a consultant in obstetrics and gynaecology at Ninewells Hospital in Dundee, said yesterday there were four main factors which had increased the Caesarean section rate in Scotland over the last decade.

He said it was undeniable that the figures had risen because more women than ever before were exercising their right to choose a Caesarean section long before the date they are due to give birth, even when there is no specific medical reason for them to undergo the operation.

"If someone comes to us with that request we would first explain to them that the national guidelines do not support it, and then spell out to them that there are risks involved in having a Caesarean section.

"While there are still consultants who will say no, the trend among consultants is moving towards agreeing to a woman’s informed consent," said Dr Chien.

The second - and more common - reason for the increase in Caesarean sections is the growing number of times the operation is done as an emergency.

A decision to undertake an emergency Caesarean is taken when either the baby is in distress or the mother’s labour is too slow in its progress.

It appears that more and more women are ready to give up on natural labour if it has gone on for longer than they were expecting - although many report feeling deeply unhappy that their child was born by Caesarean section despite their attempts to give birth naturally.

The third reason is that once a woman has had a Caesarean section she is 50 per cent more likely to have her subsequent children by the same method, according to Dr Chien.

He explained: "Once you have had a Caesarean section you have a surgical scar on the uterus and that means you are unable to push as hard as someone with an intact uterus during natural labour.

"Also these patients are more likely to opt sooner for a section if they find natural labour is not progressing quickly."

The fourth reason for the increase is that hospitals will no longer deliver babies in the breech position by any other means than Caesarean.

Shona Robison, the SNP health spokeswoman, said yesterday: "This is something that has to be looked at, and it is a worrying trend. While there are some good clinical reasons for people opting for a Caesarean, this dramatic increase shows many of these decisions are not being made on clinical grounds.

"What we need is to look at why that is and try to have some sort of public health campaign to promote non-Caesarean births, because they have been the subject of a lot of misconceptions and fear."

The Scottish Executive said it was keen to reduce the number of Caesareans.

Three expert reports have found that women should be encouraged to attempt a natural birth.

A spokesman said: "[These reports] highlight the need for midwife-led care and the promotion of normality in childbirth, with a view to a reduction in interventions.

"NHS boards across Scotland are expected to adopt the principles and recommendations in all three of these reports."

'Traumatic' surgery should only be used as a last resort

ANGIE BROWN

DEBORAH Ryan gave birth to her son Dechlan by Caesarean section seven weeks ago but still feels tender and swollen along her four inch scar.

The 33-year-old mother from Edinburgh only underwent the procedure after becoming exhausted following five days attempting to have a natural birth.

She admitted it was a traumatic experience. Mrs Ryan, from Edinburgh, suffered complications due to serious injuries she received during a car accident two years ago.

She said she felt "very squeamish" during the operation because she could hear cutting and feel her organs being moved about.

The former advertising executive warned other mothers against having the major surgery, which she believes should only be used as a last resort.

"These mothers who choose to have Caesarean sections because they feel they are ‘too posh to push’ are shocking and should be ashamed of themselves.

"Women have had the ability to have a natural birth since Adam and Eve and it is only because I am disabled that I finally had to relent and have a section.

"I made sure they tried everything on me first though, including being pumped four times with hormones, having several internals, massage, aromatherapy and my waters broken at the hospital, but still I was unable to be induced and my baby was in distress.

"Having a section is absolutely horrendous because you usually only have an epidural, which means you can feel them pulling and moving organs about and hear them cutting through fat and muscle. It is a horrible sensation and lasts for about 30 minutes.

"I kept telling my husband to keep talking to me throughout the whole operation to stop me thinking about what was going on. Then you are unable to hold your baby for another 30 minutes while they sew you up."

She added: "I also wouldn’t recommend having a section because the recovery period takes much longer than a natural birth. For weeks I was unable to drive, bend or lift anything. Breast feeding was also very difficult because I couldn’t lay him on my stomach. Nobody should take the decision to have a section lightly."