Soaring rate of caesarean births linked to legal action fear

Women are unnecessarily having caesareans because of a lack of senior labour ward staff and doctors' fears that they will be sued if anything goes wrong, research in a new book has found. But according to consultants the rising caesarean rate is also down to more "too posh to push" mothers who expect a pain-free birth.

The book, co-authored by the natural birth campaigner Wendy Savage, shows that nearly one in four births - 22.9% - were by caesarean last year, compared with 13% in 1993 and 5.3% in 1973. The statistics contain a wide variation at different hospitals. More than 33% of births at St John's hospital in Chelmsford, Essex, are by caesarean, compared with 10.9% at Gilbert Bain memorial hospital in Lerwick, Shetlands. The National Childbirth Trust said that part of the reason was that some hospitals had more midwives and senior staff in labour wards.

In a survey of 100 consultant obstetricians for Caesarean Birth in Britain - an update on a book published in 1993 - 52 said the increase in caesareans is down to "defensive medicine" to avoid litigation.

Legal experts believe that negligence claims resulting from maternity cases amount to 60% of the total amount of compensation paid out by the NHS. The figure is disproportionate to the number of individual cases, and is skewed because the payouts for families when a child is harmed for life at birth are often high.

Some 45 of the obstetricians surveyed mentioned reduced skills among junior staff, lack of senior doctors, and lack of supervision, resulting in labour ward staff erring on the side of caution.

Prof Savage's licence to practice was threatened in the 1980s when she was accused of endangering lives by avoiding the use of caesareans. She was cleared and has since been a longstanding member of the General Medical Council. She said: "In the past doctors would not automatically say yes when a mother requests a caesarean. Now it's seen as the woman's right to choose and obstetricians have an underlying fear of suggesting otherwise in case anything goes wrong and they are sued. The doctors might see it as a simple solution but they don't necessarily see the woman struggling to care for her baby after such a major surgery."

James Walker, a consultant at St James hospital in Leeds and spokesman for the Royal College of Obstetrics and Gynaecology, said caesarean rates were going up in part because of the increased safety of the procedure. Mary Newburn, head of policy at the National Childbirth Trust, said: "Inexperienced staff and those under pressure are more likely to intervene. Where there is a consultant obstetrician on the ward it is far less likely."