Caesarean births: high number and postcode variation worries experts

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Large variations in the numbers of babies delivered by caesarean section emerged today in figures showing a breakdown of how many mothers had had the procedure in various parts of Britain.

... a third of babies born at London's Chelsea and Westminster NHS trust are delivered by caesarean section, a figure more than double that in Nottingham, suggesting the rates for the procedure in England could still be influenced by well-off women dubbed "too posh to push".

The Chelsea and Westminster trust, which tops the league at 33.3% of births by caesarean, said that its numbers were swollen by women giving birth in its private delivery wing.

Other hospitals in London and the south also have rates that are significantly higher than the England-wide average, of 24.6%. The figure for Imperial College Healthcare NHS trust was 33.1%, that for Surrey and Sussex Healthcare NHS trust 30.9%, for Barnet hospital 30.8%, and for university hospital Lewisham 30.6%.

The lowest rate of caesareans was 15.8%, at Sherwood Forest NHS trust in Nottingham.

Nearly half of Chelsea and Westminster's caesareans were planned rather than an emergency; 15.8% of deliveries were by elective caesarean, which is three times the proportion of the Peterborough and Stamford NHS trust, where 5.6% of deliveries were elective caesareans.

Chelsea and Westminster insisted that all its caesareans were done for "clinical reasons" and said the hospital was a regional referral centre for sick babies, many of whom were delivered by that method. But it said it was taking steps to bring the rate down, by measures such as increasing the consultant cover on wards, and providing one-to-one midwife support for women in labour.

... "There is now general acceptance among maternity services' professionals that the caesarean section rates are too high and that some women and their babies are being subjected to unnecessary [medical] interventions. ... different attitudes and practices among professionals can lead to lower or higher [caesarean] rates. While most caesareans will be straightforward, there are potential complications for women and their babies."

... the "staggeringly high number of caesarean sections" was a serious cause for concern. "The fact that the rate is nearly double that recommended by the World Health Organisation is deeply worrying, especially given the concerns about the increased risks of the procedure. We urgently need to increase the number of midwives … so that mothers are given all the advice and support they need during and after pregnancy."

Australia's caesarean rate is not much further behind at 31% in 2006.

Melissa Maimann, Essential Birth Consulting 0400 418 448