Rise in Caesarean births alarms doctors

Study reveals unnatural deliveries 'have doubled'
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Ministers are to examine the first national study into the rising numbers of Caesarean births, which cost the NHS £80m a year. The study will show the number of operations has doubled in a generation, with more than one in five babies now delivered by this method.

Ministers are to examine the first national study into the rising numbers of Caesarean births, which cost the NHS £80m a year. The study will show the number of operations has doubled in a generation, with more than one in five babies now delivered by this method.

The survey, commissioned by the Government and done by the Royal College of Obstetricians, was completed only last month. It shows that normal childbirth is in decline as British women, advised by their doctors, opt to go under the surgeon's knife to have their babies. Ministers will consider claims that women are being denied a natural birth and the NHS is spending millions of pounds without reducing the risks to mother or baby.

Doctors, midwives and women's groups, alarmed by the growing medical intervention in births, cite the rise as one of the worst examples of medical practice driven by fear of litigation. Babies brain damaged at birth have won multi-million- pound damages awards.

Others argue that it is the modern way to give birth, using technology to provide a safer and pain-free delivery. In some private hospitals in the US and South America, Caesarean rates are up to 80 per cent as professional women seek to schedule births to fit with busy lives and avoid the risks of a vaginal delivery.

The RCOG survey, conducted with the royal colleges of midwives and anaesthetists and the National Childbirth Trust, is the most comprehensive to be done, involving all 237 maternity units in England and Wales. Detailed information on 125,000 deliveries between 1 May and 31 July was collected and the results are now being analysed.

Although final figures are not yet available, experts say they will show that the national Caesarean rate has exceeded 20 per cent for the first time. Professor James Drife, spokesman for the Royal College of Obstetricians and consultant at St James' University Hospital, Leeds, said: "It wouldn't surprise me. It looks as if the rate is no lower than we thought."

Department of Health figures show that Caesarean births increased from 9 per cent in 1980 to an estimated 17 per cent in 1997. In 1998-99, a survey by the English National Board for Nursing, Health Visiting and Midwifery found a quarter of maternity units had Caesarean rates of 20 to 30 per cent, and one in 50 had a rate above 30 per cent. The World Health Organisation recommends that the acceptable rate for Caesareans in developed countries is 10 to 15 per cent.

Claims that the rise is being driven by demand from women will be tested in the second phase of the survey, now being planned, which will seek patients' views on delivery.

Jane Thomas, who is leading the study, said celebrities who have had Caesareans, including the Spice Girl Victoria Adams and the All Saints star Melanie Blatt may have boosted interest. Dr Thomas said: "We want to find out if the Caesarean rate is rising because women are choosing it - and if so why - or whether it is because doctors and hospitals have different policies on it."

Professor Drife said that there was still uncertainty about the risks and benefits of different modes of delivery. He said: "The main factor [driving the rise] is risk averseness among women and their doctors. It is not one party forcing their decision on the other, it is a communal decision about avoiding risk."

Women are being sought to help develop the questionnaire for the second phase of the study. Potential volunteers should contact Alison Callwood, research fellow at the RCOG, on 020 7772 6380.

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