Caesarean rate rises again to reach 23% of births

Caesarean births are up again, new government figures revealed yesterday, suggesting that last year's halt in the rise was just a blip in a long-term trend of increasing medical intervention in childbirth.

Midwives and campaigners expressed disappointment. The caesarean section rate has climbed from under 3% in the 1950s to 12% in 1990-91 and appeared to plateau at 22% last year, which was no change on the year before. But the latest figures, for 2003-04, show it has now reached 23%, despite efforts to encourage normal deliveries.

Half of the caesareans (11%) are elective - performed by prior arrangement perhaps because the woman has a scar from a previous caesarean which can make normal delivery more risky, or in some cases because the woman does not want a vaginal birth. The rest are emergency caesareans.

The Royal College of Midwives said the caesarean rate was too high. "We are disappointed and troubled by the rise of the caesarean rate, despite our support for normal births," said Dame Karlene Davis, its general secretary.

"We believe that caesarean delivery is appropriate and beneficial in only 10 to 15% of all births, as specified by the World Health Organisation. As it stands, one in four babies being delivered by caesarean is simply too many."

The college was concerned that some caesareans were being carried out "as a matter of course rather than medical necessity", Dame Karlene said, and it worried that some women might not realise that the procedure is major abdominal surgery, "posing a significant risk to women, including wound infection and serious complications such as bleeding, blood clotting and bladder injuries". She called for all women to receive full and unbiased information on the comparative risks and benefits of caesareans versus normal births.

Brenda Phipps, the chief executive of the National Childbirth Trust, was also disappointed: "Maternity units are generally aware and concerned to bring their caesarean rates down and we hoped that the trend would have been downward following last year's statistics showing no increase. However, these figures show that medical intervention is continuing to occur in a high proportion of cases.

"Frustratingly it is fairly simple measures that would help increase the normal birthrate, such as ensuring all women in labour have a midwife with them that they know, who is free to give the woman her full attention for the whole of her labour."

The figures include only those NHS maternity units that have collected data - around 72%. They do not include private hospitals such as the Portland in London, where there is a much higher caesarean section rate.

Less than half of all the deliveries (46%) were completely "normal", in the sense of no medical intervention at all. An additional 2% of women were delivered at home. More than one in five deliveries were induced, as in the previous year, and about 12% were assisted by use of the forceps or ventouse.

Around a third of women had major anaesthesia, an epidural, spinal or general anaesthetic.

Forty units did not hold complete data on the deliveries that had taken place. BirthChoiceUK, which gives women information about maternity units to help them choose where they want to go, said this was regrettable.

"These latest statistics have been compiled with only 72% of the necessary maternity records," said Miranda Dodwell of the information service. "We find it disappointing that some hospitals have not submitted any usable records.

"We believe that trusts have a duty to produce details of the maternity care they provide in order to be accountable to both those that fund the service and those that use the service."