Rising c-section rates among first-time mothers strongly linked to age

One in four or 25% of first births were to women aged 35 years or older in 2017 compared to 14% in 2008.
Rising c-section rates among first-time mothers strongly linked to age

The HSE’s newly published Perinatal Statistics Report has found the number of first-time mothers in Ireland over the age of 35 has nearly doubled in recent years. Picture: PA

Rising caesarean section rates among first-time Irish mothers has been found to be strongly linked to increasing maternal age, according to a new study.

The findings in the new study carried out in the Coombe Women and Infants University Hospital are important in the light of evidence that Irish women are choosing to defer having their first baby until later in life.

The HSE’s newly published Perinatal Statistics Report has found the number of first-time mothers in Ireland over the age of 35 has nearly doubled in recent years.

One in four or 25% of first births were to women aged 35 years or older in 2017 compared to 14% in 2008.

The report from the Healthcare Pricing Office found that in 2017, just over three out of ten or 31% of single live births were delivered by caesarean section while 54% of women delivered spontaneously.

It also found obese women were more likely to have their babies be delivered by caesarean section in 2014 than in 2009.

Professor of Obstetrics and Gynecology at the UCD Centre for Human Reproduction at the Coombe, Michael Turner, said there are a number of factors for the rising caesarean section rates in older mothers.

He said: “There is no single explanation for the increase in caesarean section rates in older women especially over 35 years.

“One is that older women are more likely to have a history of pregnancy loss or to have had treatment for infertility.

“They may be risk-averse because fertility levels decrease with age and their opportunities for childbirth in the future are less.” 

Professor Turner, who is one of the authors of the study along with Dr Aoife Brick, added that older women do not labour as efficiently because the uterine muscles are not as powerful.

“This is not surprising because all our muscle power decreases as we age”, he explained.

The obstetrician didn’t believe the rise in C-sections was due to a rise in women requesting the procedure.

“The number of women requesting a caesarean section is in my experience relatively low in Ireland”, he said.

He added: “In general, obese women are twice as likely to have a cesarean section as nonobese women.” The study found increasing caesarean section rates in first time mothers were found to be strongly associated with the trend for women waiting until later in life to start a family.

“(This) is important because of the evidence that Irish women are choosing to defer having their first baby until later in life”, said the study.

One in four or 25% of first births were to women aged 35 years or older in 2017 compared to 14% in 2008. Picture: PA
One in four or 25% of first births were to women aged 35 years or older in 2017 compared to 14% in 2008. Picture: PA

Professor Turner said first time mothers are more likely to have an emergency caesarean section while women with two or more pregnancies are more likely to have an elective caesarean section which is usually a repeat caesarean section.

He said: “There are no national guidelines for caesarean section and this is also true for other countries.

“The caesarean section rate per se is not a concern and it is escalating in all developed countries.

“The biggest concern for WHO is women not having a caesarean section because of the absence of human resources in developing countries.

“However, there are cases where a caesarean section may (be) medically unnecessary and may be a concern.” 

The new study - Does maternal obesity explain trends in caesarean section rates? - has just been published in the Irish Journal of Medical Science.

The study found that although the prevalence of being overweight or obese changed little over the period, the odds of having a caesarean section if a woman is obese have increased for women with two or more pregnancies.

The researchers said in their study that almost one in five women delivered in 2017 in the Coombe Women and Infants University Hospital was obese at her first antenatal visit.

The number of women with obesity, including women who are morbidly obese, has been shown to be increasing over time.

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