Third of women giving birth by c-section with main-factor seen as increasing age of first-time mothers

One-in-three Irish women gives birth by caesarean section, with the increasing age of first-time mothers seen as the main factor.

The first national report gathering together information from all 19 maternity units has also shown that epidurals were used in almost 41% of births and that just under 30% of labours were induced.

Professor Michael Turner, lead of the National Clinical Programme in Obstetrics & Gynaecology, said the report showed that Ireland’s figures across the various sections were in line with international averages, adding: “There are no alarms bells going off.”

As for the growing rate of caesarean section births, he said the later ages at which women were having their first child was “a factor pushing up the c-section rate”.

“What I can say is that it is not because babies are getting bigger,” he said. “It would appear to be related to women delaying having their first baby.”

According to the Central Statistics Office the average age of first-time mothers in 2014 was 30.5 years, up 0.3 years from 2013 in what has been a continuing trend. In the first quarter of last year the average age of first-time mothers was 30.6.

Having a c-section has also become much safer but Prof Turner dismissed any notion of more women simply electing to have a c-section as “exaggerated”.

“Women in Ireland are very focussed on the safety of their baby,” he said, adding that Ireland’s c-section rate was the closest to the OECD average of all countries included in a 2013 report.

The figures are contained in the first Irish Maternity Indicator System National report, which gathered data from all maternity units around the country for 2014.

The report — the first of its kind in the world — shows that in 2014 there were 67,263 births involving 65,987 mothers, with the National Maternity Hospital in Holles Street recording the highest number of births and South Tipperary General Hospital the lowest number.

The figures show the larger hospitals have higher rates of multiple deliveries and that there has been a downward trend nationally in the number of live births in Ireland, from 71,986 in 2009 to 69,267 in 2013 — a drop in the live birth rate from 16.7 to 15.0 per 1,000 population.

As for multiple births, six units display incidence of multiple births above the national average and five of these have an IVF unit or clinic.

First-time mothers tend to be at greater risk than other women of adverse birth outcomes, but the national maternal death rate is very low at 10.61 per 100,000 mothers delivered, while the perinatal death rate is 6.05 per 1,000 births, although those behind the report stressed that some of these figures should be approached with caution.

Meanwhile, 40.83% of births in 2014 involved the administering of an epidural, while the rate of instrumental delivery, including forceps delivery and vacuum extraction, was 15.48%.

Prof Turner said that women used other forms of pain relief or have short labours, reducing the likely need for any epidural. The report shows just under 30% of labours were induced, with first-time mothers more likely to be induced.

The report does not detail how individual hospitals compare across the 30 different categories although each hospital has been provided with its individual data. Prof Turner said: “The outcomes are being monitored very closely.”

He said the fact that none of the figures were out of step with international comparators was “reassuring” and that a report for 2015 is likely within the next three or four months.

The general secretary of the Irish Nurses and Midwives Organisation (INMO), Liam Doran, said the system needed around 475 more midwives and that existing staff “work miracles”.

He said the report was fair, and that the image of maternity care had been affected by some “bad incidents” in recent years which did not reflect the overall level of service.