Natural birth in decline as 1 in 5 has Caesarean
Celebrity mothers and middle-class women lead the rising trend towards intervention in the delivery room, maternity study suggests
The largest study of childbirth ever undertaken in Britain has shown that normal delivery is in decline as increasing numbers of women go under the knife.
The study of 158,000 births last year, a quarter of the total, has found that 21.5 per cent, more than one in five, were delivered by Caesarean section. The highest rate was 56 per cent in an unnamed private maternity hospital.
The proportion of babies born naturally – requiring no intervention such as a Caesarean or forceps – has slipped to 67.3 per cent, down 10 per cent compared with a decade ago and at its lowest level for more than 25 years.
The study, by the Royal College of Obstetricians and Gynaecologists, in association with the royal colleges of midwives and anaesthetists and the National Childbirth Trust, is the most comprehensive carried out, involving all maternity units in England, Wales and Northern Ireland.
It showed for the first time that just over half of consultant obstetricians were themselves worried that the Caesarean rate in their own unit was too high. Nationally, the rate stood at nine per cent in 1980 and has been rising at one per cent a year for a decade. It is now well above the World Health Organisation's recommended level of 10-15 per cent.
One factor behind the rising trend is thought to be that middle-class women dubbed "too posh to push" are demanding Caesareans, in the belief that they are safer, and obstetricians are becoming less resistant.
Celebrities including former Spice Girl Victoria Beckham, actress Patsy Kensit and presenter Zoë Ball have fuelled the trend. The survey found that seven per cent of all Caesareans were in response to a request from the mother and were carried out for no medical reason.
The rise is accelerating because women who have had one Caesarean are more likely to deliver the same way the next time. Fear of litigation has also been suggested but researchers said there was no evidence that it was a reason for the rise.
Jane Thomas, chief author of the survey, said: "The threshold [for performing a Caesarean] may well have moved as mothers get better at asking for what they want and clinicians become less worried about it."
Most consultants (78 per cent) felt that a planned Caesarean was not the safest option for the mother although half (51 per cent) felt it was safest for the baby.
The Caesarean rate was higher in London and Wales (24.2 per cent) and lower in the North-east (19.3 per cent). The highest rate was in the Channel Islands and the Isle of Man (24.8 per cent).
Professor Bill Dunlop, president of the RCOG, said: "The audit shows marked variations in rates across the country and that obstetricians are rightly concerned that the Caesarean rate in the UK may be too high. We need to make sure that when Caesareans are carried out they are done in appropriate circumstances."
Guidelines for maternity units based on the findings will be drawn up by the National Institute for Clinical Effectiveness (NICE), Jacqui Smith, a health minister, said. "Women should be free to make choices during their pregnancy," she said.