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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Dr John Whittington,
Voice: +44 (0) 1296 730225
Mediscience Services
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