Rise in Caesareans blamed on shortage of consultants

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The rising rate of emergency Caesarean sections is being driven by the lack of skilled obstetricians experienced in managing difficult vaginal births, senior doctors have warned.

And they say the situation will worsen unless more doctors can be recruited into the specialty. The Royal College of Obstetricians said last year that the proportion of UK graduates choosing obstetrics had halved in a decade.

Professor Allan Templeton, president of the college, said then: "The future of obstetrics and the future of women's health in this country depends on a focused response to this stark reality."

Research shows consultants are more likely to allow a woman experiencing a difficult second stage of labour - when she starts to push - to proceed to a vaginal birth. If the baby seems stuck, the mother may be helped by using forceps or the ventouse [suction] method. But most women are assessed in the second stage of labour by senior registrars, who are in training for consultant posts, and they are more likely to opt for a Caesarean when the birth is difficult.

More than a third of Caesareans are performed because of a failure to progress in labour, and the rate is rising. The overall Caesarean rate has soared in Britain from 9 per cent in 1980 to 22.3 per cent, more than one in five of all births.

In the British Medical Journal, three experts say many emergency caesareans could be prevented. "A consultant obstetrician who performed a vaginal assessment was more likely to reverse a decision made by an obstetric trainee for a Caesarean and proceed to a safely conducted instrumental delivery," they said.

Emergency Caesareans carry an increased risk to the mother of haemorrhage, damage to the bladder and tearing. The authors call for better training for senior registrars in the use of forceps and ventouse.

They added: "Without increases in junior doctors' experience and recruitment into the specialty, the problems with second-stage Caesareans will rise. Women who undergo a Caesarean section are less likely to have a vaginal birth in subsequent pregnancies because they tend to request repeat elective Caesarean delivery."

Concern about the rising rate of Caesareans has focused attention on the factors driving it. The World Health Organisation recommends a Caesarean rate of 15 per cent.

Initially, the rising trend was driven by doctors who feared litigation because obstetric cases form the bulk of medical malpractice claims. Intervention, whether surgical or by use of forceps or other methods, appeared safer.

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