World Health Organisation drops its caesarean rate figure

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The World Health Organization … had previously advised that no more than 10 to 15% of babies be delivered by section …But now the WHO states that "there is no empirical evidence for an optimum percentage" and stresses that "what matters most is that all women who need Caesarean sections receive them".

Yet in the NHS, doctors, hospitals and midwives have been under pressure to persuade women to give birth naturally. So should there be less pressure on women to avoid surgical intervention?

… Janet Fyle, from the Royal College of Midwives, said she believed the WHO's original target was right, although nobody had kept to it.

"If a woman has a normal birth her outcomes and her chances of recovery are much better than someone who has gone through a major operation like a Caesarean."

The surgical procedure means that both mothers and babies face slight risks, although often these risks are outweighed by the problems of proceeding with a natural birth.

Experts point to an increased risk of respiratory problems for the baby, higher risk of bleeding for the mother and a longer stay in hospital to recover as reasons why natural births are the preferred option.

… Professor James Walker, consultant obstetrician at St James's University Hospital in Leeds and spokesman for the Royal College of Obstetricians and Gynaecologists, says targets are not helpful for Caesareans.

"If you set a target then people focus on that target. What we should be doing is giving optimal care to the mother. That way we minimise the reasons for a section.

"Having a Caesarean section is a reasonable option, but it's about the appropriate treatment for the appropriate people," he said.

Health professionals are regularly heard to say that giving birth is an unpredictable business. The key issue for many is having the right professionals around who understand pregnancy and birth so that women can be helped through their labour experience.

'Normal birth'

In situations where a woman experiences complications in labour, says Maggie Blott, consultant obstetrician at University College Hospital in London, a Caesarean should be carried out for the right reasons.

"My job is not to perform Caesareans, it's to prevent them happening.

"To help this process decision-making must be correct at a senior level and consultants should be available on labour wards all the time to advise," she said.

The RCM's Janet Fyle said: "There are many reasons to deliver babies by planned or emergency Caesarean, but we should be doing all we can to support women to have a normal birth, where possible."

Having a good mix of staff on the labour wards, including senior midwives and consultants, is seen as key to keeping Caesarean rates down ...

Melissa Maimann, Essential Birth Consulting 0400 418 448