The practice of caesarean birth in the UK

A survey of 231 clinical directors in obstetrics and gynaecology in the British isles in 2005 asking about attitudes and practice relating to Caesarean Section (CS) had a 68.3% response rate. This paper reports on consultants' practice. Since our previous survey done in 1990 relating to births in 1989 the use of epidural anaesthesia had increased and the vast majority of caesarean sections were done under epidural or spinal aneasthesia and the majority of consultants allowed the partner to be present at the birth compared with 55% in 1989. Practice varied considerably between consultants in regard to the risks of surgery routinely mentioned, the proportion who would allow a trial of scar after two previous CS and those who would perform a CS at 24 weeks for fetal distress. A third accepted the NICE guidleines about CS fully and only 5% did not accept these with 61% accepting partially despite the lack of evidence for some of their recommendations. The proportion of women monitored routinely in labour had dropped from 45% to 11% although half still had an admission strip performed despite the 2001 guidelines. Few had read, the FIGO Ethics committee recommendations about non-medically indicated CS and it is suggested that the RCOG should bring such information to the attention of members through O&G news. A leaflet explaining the possible risks of CS and the long term implications should be produced by the RCOG alone or in conjunction with the Dept of Health so that women are better informed about these.