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Updated: Jul 13, 2026
08:49
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
British consultants' attitudes to caesareans
1School of Health and Social Policy, Middlesex University, London, UK. wdsavage@doctors.org.uk
Summary
Clinical directors report rising caesarean rates, citing fear of litigation, patient requests, and staff skills as key drivers. They advocate for increased consultant involvement and VBAC to reduce rates.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Management
- Medical Ethics
Background:
- The caesarean section (CS) rate significantly increased globally between 1990 and 2004.
- Understanding the contributing factors and expert opinions on this trend is crucial for maternal healthcare.
- Clinical directors' perspectives offer valuable insights into the challenges and potential solutions.
Purpose of the Study:
- To explore the perceptions of clinical directors regarding the rise in caesarean section rates.
- To identify the primary reasons cited by clinical directors for the increasing caesarean delivery.
- To gather recommendations from clinical directors for strategies to potentially reduce caesarean rates.
Main Methods:
- A survey was conducted among 151 clinical directors.
- Participants provided their views on the increasing caesarean section rates.
- Data analysis included identifying common reasons and suggestions for rate reduction.
Main Results:
- The top three reasons cited for the rise in caesarean rates were fear of litigation, maternal request, and concerns about the skills of junior medical staff.
- Clinical directors offered approximately 90 different reasons for the increase.
- A majority of consultants (3/5) believed their local caesarean rate was too high.
Conclusions:
- Key recommendations for reducing caesarean rates include increased consultant input, promoting vaginal birth after caesarean (VBAC), enhancing patient education, and regular discussion in clinical meetings.
- There is substantial agreement (3/4) among consultants regarding 'no fault compensation' for cases of infant brain damage.
- Addressing the multifaceted reasons behind rising caesarean rates requires a comprehensive approach involving clinical practice, patient engagement, and policy considerations.
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