A lot of the detail you are asking about is in the bulletin. AS for the
headline caesarean figure, the difference is 0.7 with 95 per cent confidence
interval of (0.5,0.9) so I think it's justifiable to say that it rose.
Alison
-----Original Message-----
From: John Whittington [mailto:[log in to unmask]]
Sent: 31 March 2005 11:43
To: [log in to unmask]
Subject: Re: Maternity statistics for England published to day
At 10:28 31/03/05 +0100, Macfarlane, Alison wrote (in part):
Maternity statistics for England for the financial year 2003-04 were
published this morning.
The caesarean section rate has resumed its upward trend, increasing from
22.0 per cent in 2002-03 to 22.7 per cent in 2003-04.
Over 20% of deliveries were induced, as in the previous year.
More than half of caesareans were emergency caesareans
About 12% of deliveries were instrumental deliveries, as in the previous
year
An estimated 46% of deliveries were 'normal deliveries' defined as those
without surgical intervention, use of instruments, induction, epidural or
general anaesthetic
During delivery about 1/3 of women had an epidural, general or spinal
anaesthetic
12% of women had an episiotomy.
A few initial thoughts about these figures:
1...I realise that there are problems in talking about 'statistical
significance' of year-to-year changes when one is looking at 'whole
population' data, but I have to wonder whether one can read anything
('significant') into a change of CS rate from 22.0% to 22.7% - which I
strongly suspect is well within the year-to-year 'noise level' that one
would expect even if there were no 'true' (upward or downward) trend.
2...The figures seem to imply that epidural anaesthesia for non-instrumental
vaginal delivery is much less common than I would have expected. Given that
all of the 22.7% who had Caesarean Sections, and some of those 12% who had
instrumental deliveries, will have had some sort of anaesthetic (epidural,
general or spinal), the overall figure of 1/3 having had some sort of
anaesthetic leaves little left for non-instrumental vaginal deliveries.
3...Interpretation of the figures you have presented is obviously frustrated
by some inevitable overlaps (e.g. some of the instrumental deliveries will
also have involved induction); do the published figures include breakdowns
that would allow one to unravel these overlaps?
4...The definition of 'normal delivery' seems a bit restrictive. It would
certainly be nice to also see figures for 'unassisted spontaneous vaginal
deliveries' (i.e. not excluding cases solely because of an epidural) and
perhaps also 'unassisted vaginal deliveries' (i.e. also including those
labours which were induced). Can that information be extracted from the
published figures?
Miranda Dodwell from BirthChoiceUK said
"The caesarean rate, which last year showed no increase, is on the rise
again, with increases in both emergency and planned caesaeans. However the
numbers of labours being induced fell again, as did the number of babies
whose birth was assisted by forceps and ventouse. Overall this led to a
decrease in the number of normal births - a sign that medical intervention
in labour is increasing further."
Since reductions in instrumental deliveries (and, to a small extent, the
reduction in inductions) would be expected to result in a rise in emergency
Caesarean Sections, the increase in planned Caesarian Sections (which I
imagine is what people would probably be most concerned about) must surely
be tiny if the change in overall (emergency + planned) CSs was only from
22.0% to 22.7%. Do you have the actual figures?
... just my initial thoughts!
Kind Regards,
John
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