Docs blamed for Caesarean rate

Physician behaviour in Ireland has been highlighted as a potential cause of the large increase in the number of Caesarean sections carried out here, according to a new paper published by the Economic and Social Research Institute, Recent Trends in the Caesarean Section Rate in Ireland 1999-2006.
According to the paper, the Caesarean section rate in Ireland has increased by over 25 per cent from 1999 to 2006. The rate is now more than ten per cent higher than that recommended by the WHO and is amongst the highest in Europe.

Factors like earlier gestational age of child, older maternal age at birth, higher socio-economic status of mother and birth within a private hospital do not explain the large increase, the paper argues. Such risk factors explain only half of the increase in the Caesarean rate amongst single delivery first-time mothers.
“This suggests that changes in physician behaviour over the period may well play a significant role,” the paper’s authors stated. The authors list concerns with Caesarian sections in the literature including the increased risk of accidental surgical cuts, non-establishment of breastfeeding and childhood and adulthood trauma; and Caesarean section being a more costly mode of delivery than vaginal delivery.
“The small but significant contribution of failure for the labour to progress (dystocia) in the analysis of clinical indicators may suggest that factors such as increased use of epidural anaesthesia may have played a role… Changes in practices such as this and changing technology (such as increasing use of sensors for foetal hypoxia) may explain some of the 46 per cent left unexplained in our model.
“It seems likely however that much of the unexplained component are changes in physician behaviour of different kinds. Future research should look for ways to examine this empirically in the Irish context.”