Letter: Half Caesareans are unnecessary

Sir: I have every sympathy for Gillian Morriss-Kay (letters, 7 November) who lost her first child at birth, but I suspect that this tragic stillbirth has coloured her reaction to Sheila Kitzinger's article on how to avoid a Caesarean section (CS) (Magazine, 2 November). This was hardly a polemic but an excellent summary of the steps, backed by good research evidence, that women can take to avoid an unnecessary operation.

The rate of CS was estimated by the Royal College of Obstetricians and Gynaecologists to be 15 per cent in England in 1993, whilst in Scotland and Wales the rates are higher.

In 1978, when the US rate of CS rose to 15 per cent it was recognised that a public health problem existed and a task force was set up to examine this. It took another 15 years before the rate stopped rising, peaking at 24.8 per cent, and in 1994 it had fallen to 23.6 per cent. The rate has risen more slowly in the UK but is over 15 per cent now. I estimate that half those operations are unnecessary and many could be avoided by following the excellent advice given by Sheila Kitzinger.

WENDY SAVAGE FRCOG

London N1