C-section births increase despite risks

THE number of planned caesarean births in Scotland is growing, despite well-known risks surrounding the operation. The reasons behind the increase are complex – not simply the ‘too posh to push’ cliché. But there are concerns that the caesarean – which, like any surgical procedure, has risks for both mother and baby – could become the default. With one in six women in the Glasgow area having planned caesareans, the director of the Royal College of Midwives in Scotland has called for more help for women scared of giving birth. It follows demands for a national monitoring programme to stop C-sections becoming the norm. A Freedom of Information request found more than half of births in Greater Glasgow and Clyde are caesareans. The country’s largest health board sent one in six women for a planned, rather than emergency, operation to deliver their child, despite it being far more risky than a natural birth. The procedure also costs the NHS £1,700 on average, compared to £750 for childbirth. Gillian Smith, director of RCM Scotland, said: ‘There is no doubt that some women are choosing caesareans because they are frightened to give birth. ‘We have a fear of birth clinic in Ayrshire and Arran, but we need to invest in more. It would help if programmes like One Born Every Minute would show more situations where women sail through giving birth, but that might not make good television.’ Caesareans can be planned for breech babies, who would be born upside down, and are increasingly used to avoid complications in overweight mothers. NHS Ayrshire and Arran said the operation is part of a woman’s ‘informed choice of delivery’, and carried out 445 planned caesareans in 2013-14 – the same number as emergency ones. Across the country, 12 per cent of babies are born this way. A Freedom of Information request, answered for the past two years by all of Scotland’s 14 health boards except Lothian and Tayside, shows the number of these operations is rising. There were at least 5,530 in 2013-14, up 3.5 per cent from 5,343 the previous year, despite the well-known risks. Women are five times more likely to die when having a C-section than giving birth. Those who have the operation may find themselves unable to have more children, are at increased risk of future stillbirths and blood clots. Mrs Smith said: ‘We need to make sure women know that a caesarean does not come without risk. It is a major abdominal operation and it can take much longer to recover than from childbirth. There are dangers from anaesthetic and risks for future pregnancies.’ The senior midwife has called for health boards to justify every procedure, following a warning from the World Health Organisation that caesareans should be performed for medical reasons only and not by choice. A spokesman for NHS Greater Glasgow and Clyde said: ‘The decision to undertake a caesarean section is made by the consultant obstetrician, in conjunction with the expectant mum, with the health and safety of both mum and

paramount.’ Public health minister Maureen Watt said Health Scotland had improved the information available to expectant mothers about childbirth.