Medical expert warns on C-sections

A SHARP rise in the number of women giving birth by caesarean section could lead to an increased risk of complications during birth resulting in a hysterectomy, a leading professor of obstetrics and gynaecology has warned.

Research by Professor Michael Turner, of the UCD centre for human reproduction at the Coombe Women and Infants University Hospital (CWIUH), states that obstetricians must take a long-term view when considering caesarean section delivery in the absence of medical need.

There has been a 400% increase in the number of women delivering by C-section over the last 40 years. A study of deliveries from the three Dublin maternity hospitals over four decades between 1966 and 2005 showed that C-section rates rose from 6% to 19%. In 2007, the national C-section rate had risen to 26.2%.

According to Prof Turner there are a number of reasons for this, for example, the operation has become much safer for mothers due to improvements in anaesthesia, antibiotics, blood transfusion and other medical advancements, and the early detection of complications, including breech presentation, and foetal distress in labour. However, the increase has also come about due to maternal requests and the obstetricians recommendations due to previous C-section delivery

Prof Turner said obstetricians controversially have reverted to a policy of “once a caesarean always a caesarean” partly out of fear of an adverse clinical outcome such as uterine rupture.

He warned, however, that obstetricians had a responsibility to take a woman’s long-term reproductive outcomes into consideration when they are contemplating primary caesarean delivery especially in the absence of sound medical indications. “A caesarean section is a surgical intervention that has made a major contribution to improving the outcome of pregnancy for mothers and their babies and in many cases it is the best option for the mother and her baby,” he said.

Prof Turner’s research paper, Peripartum Hysterectomy: An Evolving Picture, discusses the increase in C-section rates and implications for obstetricians. It argues that despite advances, it is likely peripartum hysterectomy, which is carried out after birth, will be more challenging and more complex for obstetricians.