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Midwives themselves are barrier to reducing C-sections

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Many midwives remain unconvinced of the need to reduce Caesarean section rates, the general secretary of the Royal College of Midwives has warned.

The proportion of births born by Caesarean has risen steadily for many years, but has recently stabilised at around 25 per cent of UK births. The World Health Organization recommends no more than 15 per cent.

Cutting the rate is one of eight high impact actions picked by chief nursing officer for England Dame Christine Beasley to reduce costs and improve quality, while avoiding cuts (news, page   17, November 2009).

The high impact action aims to increase the normal birth rate “through midwives taking the lead role in the care of normal pregnancy and labour, focusing on informing, educating and providing skilled support to first-time mothers and women who have had one previous Caesarean section”.

But RCM general secretary Cathy Warwick told Nursing Times it would be difficult because not all midwives and obstetricians were convinced they needed to promote normal birth, despite the risks associated with any major surgical procedure and the potential problems it may cause for future births.

Professor Warwick said: “Changing the Caesarean section rate only happens if clinicians want to change it, but they don’t necessarily see it as a problem.

“One of the reasons is that, on the face of it, it is an incredibly safe operation. Morbidity from a first Caesarean section is very small, though the problems emerge later – particularly for a third Caesarean section.”

Professor Warwick said reducing it would require a more concerted effort to show the benefits of normal births. She said: “It does need a real focus and energy behind it – it is not going to change easily.”

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