Caesareans soon may be delivery of choice, says UK expert
20 March 2001
A leading UK obstetrician has predicted that by the end of the decade, more than half of all Western women will choose a Caesarean delivery when having a baby.
Nicholas Fisk, Professor of Fetal and Maternal Medicine at London’s Queen Charlotte’s and Chelsea Hospital, told delegates at the Perinatal Society of Australia and New Zealand’s Annual Congress that for many women, the risk of Caesarean versus vaginal delivery was finely balanced, and they were therefore increasingly being involved in such decisions.
Professor Fisk said that it was wrong to deny women the choice in situations where medical research indicated that attempting vaginal birth could be riskier for the health of mothers and babies.
‘Vaginal delivery is the major aetiological [cause] factor for incontinence and prolapse in women. It is also associated with not-insignificant risks to the fetus including intrapartum [during labour and delivery] death, cerebral palsy and particularly, antepartum [before labour or childbirth] stillbirth,’ said Professor Fisk.
‘Such risks have traditionally been considered acceptable, but are arguably greater than other risks society rejects such as drink driving or riding a motorbike without a helmet. There is an urgent need for good research on the outcomes of vaginal versus elective Caesarean delivery.
‘Patient choice is all important in maternity care and, given this, I believe efforts to reduce Caesarean deliveries (which are up to 38 per cent of births in some countries) are doomed,’ Professor Fisk added.
However, Associate Professor Alastair MacLennan, Director of Obstetrics and Gynaecology at the Women’s and Children’s Hospital in Adelaide, said their research showed that Caesareans did little to protect women from post-pregnancy problems, such as prolapse and incontinence. Professor MacLennan said that nearly half the female population acknowledges some form of pelvic floor dysfunction.
Study finds long distance travel may be a risk to late-term pregnancy
Meanwhile, Conference delegates also heard about a Queensland study that has found that women who travel long distances from home during late pregnancy are risking financial and social stress in the event of a premature birth.
A large number of babies admitted to the Neonatal Unit at the Royal Women’s Hospital in Brisbane between January 1996 and October 2000, were from home addresses outside Queensland and northern NSW.
Study co-author and Head of the Royal Women’s Hospital Neonatal Unit Dr David Cartwright said that of the 20 premature infants they studied, 15 mothers were travelling through Queensland on holiday, while the 5 others were visiting relatives or attending weddings in Queensland.
‘Eighteen of these 20 women went into pre-term labour, and 14 of the babies required ventilation for an average 57 hours after birth. Three of the 20 infants died prior to discharge and the remaining 17 had an average length stay in our hospital of 41 days,’ said Dr Cartwright.
‘We are urging all women to be extremely careful about travelling any time after the start of the second trimester of pregnancy.
‘These unforeseen complications can result in a substantial financial and social burden on families,’ he warned.
Last Reviewed: 22 March 2001
