Fears on overuse of c-sections

[Posted: Tue 04/05/2010 by Niall Hunter, Editor www.irishhealth.com]

A leading consultant has warned against the overuse of caesarean sections in maternity services in Ireland.

He has warned that  while c-section is usually safe and often necessary, it should not be used lightly as its  overuse can have longer-term adverse consequences for women including in rare cases, excessive bleeding prompting the need for caesarean hysterectony.

Prof Michael Turner of Dublin's Coombe Hospital studied nearly 900,000 births at the three Dublin maternity hospitals between 1966 and 2005 and found that c-section rates rose from 6% to 19% of births during that period.

By 2007, the national caesarean rate had increased to 26.2%.

Dr Turner said reasons for the increasing prevalence of the operation include that it has become much safer over the years, an increased number of requests by mothers to have a caesarean, the early detection of complications during labour which can be dealt with by caesarean, and obsteticians tending to perform the procedure on women who previously had caesareans.

However, Dr Turner warned that obstetricians have a responsibility to take a woman's long-term reproductive health into consideration when they are considering a caesarean in first-time mothers, especially in the absence of sound medical reasons for a c-section.

Dr Turner said a c-section is a procedure that has made a major contribution to improving pregnancy outcomes and in many cases is the best outcome for mother and baby.

He told irishhealth.com that the Irish rate of caesarean section, at one-in-four births, was now not that far behind the rate in the US, where it is one-in-three.

"C-section has now become such a safe procedure that it is sometimes seen as a 'safe option' when in fact it might not really be necessary."

However, he said the decision to carry out a caesarean must always be carefully considered."In some cases, a caesarean section may not be necessary to achieve a good outcome. Women and their obstetricians should always be aware that short-term options have hard long-term consequences."

Dr Turner, a former Master of the Coombe, said many obstetricians have reverted back to a policy of "once a caesarean always a caesarean" partly out of fear of adverse clinical outcomes such as uterine rupture and/or hysterectomy. This had further fuelled the incrrease in the overall caesarean rates.

On the adverse conseqences of caesareans, Dr Turner said these can include a risk of uterine rupture if a woman labours with a previous caesarean scar, and there is a rare risk in a woman with previous caesareans of suffering a massive uncontrollable haemmorhage during labour which would be dealt with with by carrying out a caesarean hysterectony.

The overuse of this procedure was at the centre of the Michael Neary scandal. However, Dr Turner says currrently at the Coombe, such a procedure occurs in around one-in-5,000 cases. The rate in all Dublin maternity hospitals between 1966 and 2005 was around one-in 2,000.

Dr Turner's paper highlights the link between an increased rate of c-section and complications requiring total hysterectomy in labour, a drastic procedure which brings an abrupt end to a woman's reproductive potential.

The risk of caesarean hysterectomy rises with an increasing number of prior cesareans.

He said increased c-section rates also increase healthcare costs at a time when developed countries are struggling to maintain healthcare services in a recession.

He pointed out that the economic consequences of caesareans, particularly when they might not always be necessary, need to be taken into account. "The cost of caesarean delivery can be twice that of vaginal delivery in terms of factors such as anaesthesia and longer length of stay in hosptal."

He said he did not think fear of litigation was a significant reason behind the rise in caesarean sections in Ireland in recent years.

Dr Turner said in many cases, c-section was the right thing to do, but it should not be done purely for social reasons in the absence of sound medical reasons,as in some cases it can hav long-term implications for women's health.

His paper is published in The International Journal of Gynaecology and Obstetrics.

Visit irishhealth.com's Pregnancy Clinic here

Anonymous  Posted: 04/05/2010 12:33

Given the drop in maternal mortality in line with the increase in c-sections, I really cannot see the problem.

junebride  Posted: 25/07/2010 13:01

I believe the improved antenatal care has a lot more to do with the drop in maternal mortality!

Anonymous  Posted: 04/01/2011 16:26

Caesarian hysterectomy is extremely rare compared to the long term effects on a  woman's body of extended labour.

To join the discussion, register by clicking here