Caesarean rate higher in private care

Elective Caesarean sections are far more common among pregnant women who attend private consultants than among mothers delivering in the public health system, according to research.

The rate of elective Caesareans among women with private health insurance is also significantly higher than among mothers without insurance, the study by the Health Research Board shows.

The authors suggest many women, especially those with private health insurance, may be having unnecessary Caesareans. They express concern that women may be unaware of the possible negative consequences of Caesareans, which for mothers include infection and a higher risk of hysterectomy in later life. For babies, Caesareans are associated with respiratory problems and difficulties in establishing breastfeeding.

Women attending a private consultant alone were 74 per cent more likely to have C-sections than those receiving shared care from a GP and public maternity hospital. In contrast, women attending midwives alone were less than half as likely to delivery by this method.

Obstetricians have argued that the increase in C-sections has been driven by a rise in multiple births, a trend towards bigger babies and the late presentation of many pregnant women, especially immigrants.

The study, presented yesterday at the Royal College of Physician in Ireland, checked for the effect of complications in pregnancy and the age of the mother but found these had little or no impact on the figures. "The increase in C-sections often occurs in the absence of obstetrical or serious maternal complications," according to lead author Dr Udo Reulbach, a research fellow in the Health Research Board's centre for primary care research.

No blame
He said he was not "blaming" consultants for the trend, as many of the women having elective Caesareans may have expressly chosen private care in order to obtain this service. The study did not support anecdotal claims of some women being "too posh to push", as the trend toward elective C-sections did not vary across different levels of occupational household class, he added.

Of over 11,000 women surveyed, 26.7 per cent had C-sections. Slightly over half of these were emergencies but 48.2 per cent were elective.

Despite expressions of official concern, C-sections rates have been rising in Ireland for some years. At 26.7 per cent, the Irish rate is higher than the UK rate (23 per cent) and the European average of 19 per cent. The World Health Organisation recommends a rate of between 10 and 15 per cent.