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Caesarean section (CS) rates are rising globally. In Ireland, a significant increase in CS rates is linked to fewer vaginal births after a previous CS, indicating a need for evolving clinical practices.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal Health
  • Public Health Policy

Background:

  • Caesarean section (CS) rates are escalating in developed nations, with Ireland experiencing a notable increase.
  • Nearly one in three women in Ireland undergo delivery via CS.

Purpose of the Study:

  • To compare the management of women with one prior CS in Dublin maternity hospitals against practices in Massachusetts (USA) and Hesse (Germany).
  • To identify factors contributing to rising CS rates in Ireland.

Main Methods:

  • Comparative analysis of CS and vaginal birth after CS (VBAC) rates.
  • Data collected from Dublin maternity hospitals, Massachusetts, and Hesse.
  • Time-frame analysis from 1990 onwards.

Main Results:

  • Dublin's CS rate has increased substantially more than in Massachusetts and Hesse since 1990.
  • A sharp decline in the vaginal birth after CS rate in Dublin correlates with the rise in CS rates.
  • Massachusetts and Hesse had lower initial CS and higher VBAC rates in 1990.

Conclusions:

  • Changes in clinical management for women with one previous CS are a primary driver of increasing CS rates.
  • Current clinical practices require evolution to mitigate the ongoing rise in caesarean sections.
  • International comparisons highlight potential areas for improved maternal healthcare management.