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Kara Dent, West Midlands Perinatal Institute, 21/06/2001

Review on Caesarean Sections


There has been much concern in the rising caesarian section rate seen over the last 2 decades. This rise has been attributed to several different factors: surgical delivery of breeches, "daylight" or "defensive" obstetrics or simply for patient request. Financially, the audit commission in England and Wales estimated that a 1% rise in the LSCS rate costs the National Health Service £5 million (Reference1) This needs to be offset by the cost of litigation - although it is interesting to note that there has been no decline in the rate of litigation seen in line with the rise of caesarian section rates.

In this era of evidence-based medicine, the issue of informed consent, and thorough counselling, is an important one. Many papers concentrate on the maternal issues, forgetting the fetal viewpoint. Using data from the UK Confidential Enquiries into Maternal Deaths (1998), it was calculated that an elective section carries a 2.84 fold greater chance of maternal mortality over a vaginal birth, if there is no emergency present (Reference2). The fetus also carries a risk: 1.9% chance of a knife laceration (which goes up to 6% if not a cephalic presentation), RDS and iatrogenic prematurity (Reference2)These are factors that need to be presented to the mother in order that she can make a considered decision. Many Obstetricians feel helpless in light of a woman's right to choose. The fact that a patient has the right to refuse medical intervention is unquestioned, but do they have the right to choose a surgical intervention when there is no medical cause? Interestingly, the FIGO ruling in 1999 considered the ethical issue raised here and stated " Perfoming caesarean section for non-medical reasons is ethically not justified." (Reference3)


1. Editorial. What is the right number of caesarean sections? The Lancet 1997;349(9055):815, Abstract
2. Hall MH. Maternal mortality and mode of delivery. Lancet 1999;354:776, Abstract
3. FIGO committee for the Ethical Aspects of Human Reproduction and Women's Health. Ethical aspects regarding caesarean delivery for non-medical reasons. Int J Obst Gynecol 1999;64:317-22


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