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Report warns of ‘lack of consensus’ over C-section practice in EU

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Caesarean section rates vary widely across Europe with percentages of women giving birth by caesarean ranging from 52% in some countries to 15% in others, according to a new report.

Around a quarter of births in the UK are by Caesarean section, according to the Euro-Peristat study, while the highest rates were found in Cyprus and the lowest were seen in Iceland.  

The study authors said the findings highlight a clear lack of consensus about good obstetric practice.

“The differences observed raise questions about why there are such wide variations in clinical practice”

Alison Macfarlane

Further research is needed to investigate the reasons for the differences, including exploring the impact of differences and the attitudes of parents and professionals.

The Euro-Peristat project is a collaboration between 26 member states of the European Union, as well as Norway, Iceland and Switzerland.

It is the first study to show the wide differences between countries of the EU, Norway, Iceland and Switzerland in practice across a range of different situations, such as first-time mothers and breech births.

For example, the study authors said under half of multiple births in Norway, Iceland, Finland and the Netherlands were born by caesarean section, compared with over 90% in Malta and Cyprus.

Meanwhile, fewer than three quarters of breech births in Norway and Finland were by caesarean section, compared with over 90% in the Czech Republic, Germany, Italy, Cyprus, Luxembourg, Malta, Scotland and Switzerland.

Lead researchers Professor Alison Macfarlane, from City University London, said: “The differences observed raise questions about why there are such wide variations in clinical practice.

“This means we need a comparative review of national policies and guidelines and further research to ensure that clinical practice is based on evidence, and to prioritise the health of mothers and children,” she said.

Findings from the study Euro-Peristat were published in BJOG: An International Journal of Obstetrics and Gynaecology.

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Readers' comments (2)

  • It would be helpful to know a lot more about the mothers who were included in this interesting study. General characteristics , rate of diabetes, size of infants and other contributing factors as well as the likelihood of litigation when things go wrong, would all give an insight into the reasons for differences discovered in caesarean section rates. Women often find recovery from a caesarean section no more challenging than recovery following a difficult vaginal delivery, and for breech delivery it is perhaps rightly viewed as the safest option. With good outcomes,spinal anaesthetics and fast recovery times, for those who can afford to pay privately it is often their first choice.

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  • In the hands of an experienced practitioner an uncomplicated vaginal breech can be safe. Over time, in the uk, and possibly other countries as well, skill has been lost. No one would want an inexperienced person conducting a vaginal breech delivery! And they also need skill and experience to assess whether it IS likely to be uncomplicated...
    As C/S has become safer there is no place for a risky breech delivery or Keillands forceps procedure.
    Normal childbirth is vaginal but should NEVER at the risk of morbidity for mother or baby. There is no place for 'heroically' acheiving a vaginal delivery, it's not a competition.
    It would be interesting to compare APGAR scores, establishment of feeding, how 'settled' the babies were and their long-trm development...
    then there's the mothers - What are their own expectations of their ability to birth a child, their physical and emotional condition going into labour. And after delivery,do they fail to breastfeed, rates of post-natal depression, subsequent normal deliveries...
    The 'correct' rate for C/S was a hot topic when I was a student midwife 30 years ago. I'm sure we'll still be studying and debating all the issues in 30 years time.

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