Royal College of Midwives warns about high number of 'risky' operations

Popular prejudice about the demanding women of west London, with their busy lifestyles and high-profile careers, is confirmed today with figures showing the local NHS trust is the Caesarean capital of Britain.

The flagship Chelsea and Westminster NHS Trust tops the league table of English hospital trusts with the highest rate of Caesarean-section deliveries in the country, inviting the irresistible conclusion that its mothers are "too posh to push".

One in three (33.8 per cent) of the 5,230 deliveries at the trust was delivered by Caesarean, more than twice the rate at Sherwood Forest Hospitals Foundation Trust, Nottingham (15.8 per cent).

Many Caesareans are performed as emergencies when something goes wrong with the natural birth. But the rate of "elective", or planned, Caesareans at the Chelsea and Westminster, some of which are at the request of the mother, also outranked all other trusts at 15.8 per cent.

The proportion of elective Caesareans was three times higher at Chelsea and Westminster than at the lowest-ranked Peterborough and Stamford NHS Trust, which had a rate of 5.6 per cent.

The Chelsea and Westminster has topped the league table for the past two years. The highest Caesarean rates are in London and the South-east and the lowest in the North-east and Yorkshire.

Chelsea and Westminster Hospital is a favourite among celebrities, who are drawn to its private wing, which charges at least £6,000 per birth, including consultant fees. Tony and Cherie Blair chose it for the birth of their fourth child, Leo, in 2000. He was born naturally, and was the first child born to a serving prime minister in 150 years.

Tim Straughan, chief executive of the NHS Information Centre, which published the figures, said trusts should "examine closely why their rate is different from the national average".

Concern about the high number of C-sections has grown in the past decade. The rate has more than doubled over 20 years as a result of the rising number of older mothers, a "safety-first" medical culture and fears of litigation. Nationally, one in four (24.6 per cent) babies was born by Caesarean-section in England in 2008-09.

In a statement, Chelsea and Westminster NHS Trust said its figures included births from its private maternity unit. "Women who have had previous birthing problems often choose to have their baby privately. If these figures are excluded, [our] rate is 26 per cent, which is very comparable to other units in London."

The Royal College of Midwives said that the figures were of concern. Cathy Warwick, general secretary of the RCM, said: "It is disappointing that we are not seeing a drop in the Caesarean-section rate and worrying that there are such wide regional variations, given that there is general agreement that Caesarean-section rates are higher than they need to be.

"This is a major operation, with potential complications for women and their babies," she added.

The Royal College of Obstetricians and Gynaecologists said the Caesarean rate in Britain was in line with other countries in the developed world. Tim Draycott, consultant obstetrician at Southmead Hospital, Bristol, and a spokesman for the college, said: "Chelsea and Westminster may serve a more specialist population, they may have more mothers exercising choice and they may have more older mothers. London also struggles to recruit midwives for one-to-one care and that may also contribute to the capital's high rate."