Belfast Telegraph

Too many Caesarians, and not all are needed: Report says we need to cut back on £3,700 procedures

By Adrian Rutherford

Too many mothers may be giving birth by Caesarean section when it isn't necessary – putting extra financial pressure on our health service and risking added complications, a report has warned.

Northern Ireland has the highest rate of C-sections in the UK, with over a quarter of births delivered this way.

The surgical procedure, which involves making a cut in the front wall of a woman's abdomen and womb, costs around £3,700 – almost twice as much as a normal birth.

Performing the operation where it is not clinically required can also put mothers and babies at risk of infection and prolong their stay in hospital.

A report by the Northern Ireland Audit Office has found that some C-sections are being performed unnecessarily.

Auditor General Kieran Donnelly said: "Caesarean sections undoubtedly save lives and should be performed in all cases where there is a clinical need.

"However, performing unnecessary Caesarean sections poses health risks for the mother and baby and incurs additional costs."

He added: "In the current financial climate it seems particularly important that clinical managers in the health and social care trusts understand and manage the cost implications of different modes of childbirth."

However, some questioned whether it was appropriate for the Audit Office to investigate the matter.

Alliance MLA Judith Cochrane, who had two babies delivered by C-section, said decisions should always be dictated by medical opinion, not simply by a need to cut costs.

"The biggest issue is, if it is costing more and putting pressure on the health service, then we need to look at the reasons why more Caesarean sections are happening over here and address it that way, rather than just saying our goal is to cut them," she said.

Of the 25,703 babies born in Northern Ireland in the year ending March 2012, some 28.4% had been delivered by C-section.

That is higher than England (25%), Wales (25.7%), Scotland (27.8%) and the Republic of Ireland (28%).

The report also found rates varied significantly within Northern Ireland, from 24% in the Mater Hospital to 35% at Daisy Hill Hospital in Newry.

It warns interventions can pose health risks for the mother and baby.

There is also a cost factor. A normal birth costs £1,933 on average, compared to £3,724 for a C-section.

"While Caesarean sections undoubtedly save lives in certain circumstances, there is some concern that, on occasion, Caesarean sections are performed in cases where there is no clinical need," today's report states.

Auditors cited a maternity strategy published by the Department of Health in 2012 which highlighted a need to promote a culture of "normalisation" of pregnancy and birth.

Today's report also refers to a study carried out by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the National Childbirth Trust, which found that a C-section rate of around 20% was both achievable and sustainable.

Auditors also said the Welsh Assembly expects that C-section rates at hospitals within its health boards should be close to 20% and, where it exceeds 25%, boards must explain their plans to reduce the rate through improved practices.

"Reducing unnecessary interventions may improve outcomes for the mother and baby and improve efficiency in the face of increasing health care costs," it states.

Auditors found that women who previously delivered by C-section were the most likely to have the procedure.

The report states preventing avoidable C-section in first-time mothers would be a key part of reducing the need for the procedures in the future.

Fear of clinical negligence claims may be behind surgical decisions

A high rate of Caesarean section procedures could be due to clinicians' fears of legal action, today's report states.

A previous Audit Office report from October 2012 found 25% of clinical negligence claims in Northern Ireland related to obstetrics and gynaecology. Individual clinicians are not financially liable. But if clinical negligence is proved it can lead to disciplinary action and cause considerable stress.

A recent report by the Westminster Public Accounts Committee highlighted the need to address the main causes of maternity clinical negligence claims in order to stop so many legal actions coming forward.

According to today's report, Northern Ireland has the highest rate of C-sections in the UK. Auditors voiced concern that some procedures are performed in cases where there is no clinical need.

The report cites guidance from the National Institute for Health and Care Excellence on C-sections, which advocates support for women who have fears about giving birth normally.

It recommends that, in such cases, women should be provided with full information about the risks and benefits of all birth methods.

They should also be offered the opportunity to discuss their concerns with members of the obstetric team or other medical professionals.

It states that if their anxiety is not allayed by this support, then they should be offered a Caesarean section.

FACTFILE

* Celebrity mums to have undergone Caesarean sections include Victoria Beckham, who, although she was the inspiration for the phrase "too posh to push", has publicly stated that all four of her C-sections were medically necessary.

* Actress Angelina Jolie's daughter Shiloh and twins Vivienne and Knox were all born via C-section.

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