Caesareans normal by 2010: specialist

By MARTIN JOHNSTON health reporter

More than half of women having babies will opt for caesarean deliveries by 2010, a leading British doctor predicts.

"Patient choice is all important in maternity care and, given this, I believe efforts to reduce caesarean deliveries are doomed," Professor Nicholas Fisk told the Canberra congress of the Australia-New Zealand Perinatal Society.

The professor of foetal and maternal medicine at Queen Charlotte's and Chelsea Hospital in London said the risks were finely balanced between caesarean and vaginal birth.

It was wrong to deny women the choice when research indicated that attempting a vaginal birth could be riskier for the mother or baby.

But New Zealand health leaders last night sounded warnings over the risks of a caesarean delivery which, they emphasised, was a major operation.

New Zealand's caesarean rate has soared. In 1989, 12 per cent of births were by caesarean delivery, but by 1999 that figure had reached almost 20 per cent.

The rate was 25 per cent last year at National Women's Hospital, Australasia's largest maternity facility, and was at least 30 per cent at some other large New Zealand hospitals.

The Ministry of Health wants caesarean guidelines to be written in a bid to reduce the rate.

The World Health Organisation has recommended a rate no higher than 15 per cent.

In some countries now it is up to 38 per cent.

National Women's clinical leader, Dr Rob Buist, said last night that women's choice was paramount. They should be allowed to have caesareans even without medical need, but all women considering caesareans had first to be adequately informed of the risks.

He said he strongly disagreed with the implication of Professor Fisk's comments that a high caesarean rate was acceptable.

One reason for the increasing caesarean rate was that the operation had become safer because of improvements in pain relief and infection prevention.

But there were still serious risks, he said.

For instance, women having a second or subsequent caesarean faced the risk of haemorrhaging so badly that their uterus would have to be removed.

The College of Midwives president, Sandy Gray, said that if women wanted to book in for caesareans when they had no medical need they should not receive any taxpayer subsidy and should have to pay the full cost of about $6000.

She attributed the increased caesarean rate partly to the use of epidural pain relief and the artificial induction of labour.

Caesareans carried a risk of complications nine times higher than vaginal births, Sandy Gray said.

British research had shown that women tended to receive "loaded" information from obstetricians and were, therefore, more likely to opt for caesareans, she said.

The information needed to be provided by someone who was impartial - not a health worker.