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Should all women have caesareans? UK obstetrician predicts 50% will - PSANZ

A leading UK obstetrician predicts that by the end of the decade more than half of all women will choose caesarean delivery when having a baby. Addressing the Perinatal Society of Australia and New Zealand (PSANZ) 5th Annual Congress in Canberra this week, Professor of Fetal and Maternal Medicine at London's Queen Charlotte's & Chelsea Hospital, Nicholas Fisk, said that for many women the risk of caesarean versus vaginal delivery was finely balanced, and they were therefore increasi

15 Mar 2001

A leading UK obstetrician predicts that by the end of the decade more than half of all women will choose caesarean delivery when having a baby.

Addressing the Perinatal Society of Australia and New Zealand (PSANZ) 5th Annual

Congress in Canberra this week, Professor of Fetal and Maternal Medicine at London's

Queen Charlotte's & Chelsea Hospital, Nicholas Fisk, said 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 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 factor for incontinence and prolapse in women. It is also associated with not-insignificant risks to the fetus including intrapartum death, cerebral palsy and particularly antepartum stillbirth," Professor Fisk said.

"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.

"A recent survey in the UK showed that 70% of obstetricians would now allow women to elect a caesarean delivery, even if their pregnancy was progressing normally. Nearly half of all practising obstetricians in the United States said they'd opt for a caesarean delivery for themselves or their partners," he said.

"Patient choice is all important in maternity care and, given this, I believe efforts to reduce caesarean deliveries (which are up to 38% of births in some countries) are doomed."

However, Director of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Associate Professor Alastair MacLennan, said caesareans did little to protect women from post-pregnancy problems.

"Our research shows caesareans don't stop women developing pelvic floor problems

such as prolapse and incontinence. This is a silent epidemic - nearly half the female population acknowledges some form of pelvic floor dysfunction," A/Professor MacLennan said.

A debate on the benefits of caesarean delivery "Fit for the Future: Maternal Health After Childbirth" will be held at the PSANZ Congress this Friday 16 March at 8.30am EST.


Published: 15 Mar 2001