Hi Ray,

>Alison Macfarlane said earlier (11 April) that  the usefulness of the debate
>has - that started with concern about the growth of Caesarians - was
>severely limited because others with knowledge of the subject have not had
>time to contribute to the debate .
>
>But it appears that very little is known by experts or others on the
>relationship between Caesarians and age of mother.

In terms of published statistics, that does indeed seem to be the
case.  The information presumably exists for as long as the records have
been collated;  it's all but inconceivable that anyone will ever have
collected data on deliveries without the mother's age being one of the
things recorded.

>With Alison's guidance the only table I have been able to find relates to
>1995, and the breakdown with age of mother is limited to three bands - less
>than 25, 25-34, and 34 plus.   These statistics show that Caesarians do rise
>with age.  For primoparous women (I think this means first births) the
>elective Caesarian rates are given as 4%, 5% and 11% for those three age
>bands.  For emergency Caesarians for the rates are given as 9%, 14%, and 21%
>respectively.

Indeed so - and that's largely what one would expect - except that one
would also expect a bit of a rise in the 'very young'; we couldn't see
that, even if it were there, given that age is simply 'trichotomised' in
the reported statistics.

>These dated statistics and limited age breakdown do not support much in the
>way of knowledge of the part currently played by age of mother in
>Caesarians.   But it seems obvious to me the steadily increasing age of
>first births must have been a major influence on the rise in the overall
>Caesarian rate.
>Have I missed something?

I'm sure you are right, to at least some extent, but one can't tell _what_
extent.  As for what you've 'missed', I suppose it's what I said last time
- that your information on the extent to which Caesarian Sections are
related to age is 10 years old, and it's possible that it has changed a lot
since then (and may have changed a lot in the period before then).

Another important factor in addition to increasing maternal age has
undoubtedly been the fall-off of the rate for instrumental deliveries in
the last decade or two.  Instrumental deliveries are potentially very
hazardous to the babies, so there has been a progressive change from them
to Caesarian Sections in those cases in which non-intervention was not
considered to be an option.  We DO have the information on that, so one can
examine that effect.

In the absence of anyone making the full statistics available to us, the
best available source of information is probably the 'anecdotal'
information from obstetricians.  Senior obstetricians will have been
practising for 30+ years and will have a pretty good idea of how their
practice has varied over the decades, and why.

As for the terminology, it's a gloriously confused situation.  Give or take
a detail of spelling, you got the word (primiparous) right.  Traditionally,
it's just straight Latin.  'Parity' ('parousness') refers to the number of
times the cervix has been dilated by childbirth ('number oif labours') -
hence nulliparous, primparous, multiparous.  Gravidity ('heavy with baby')
is the number of times a woman has been pregnant - hence primigravid
etc.  So, traditionally, gravidity=3 and parity=2 would indicate that a
woman had been pregnant three times, and been in labour twice, the other
pregnancy presumably ending in miscarriage.  But then the fun
starts.  There are a few pedantic people out they who, realising that birth
by Caesarian Section doesn't involve 'dilating the cervix' (and doesn't
necessarily involve ever going into labour) contend that parity should
exclude Caesarian births!

Kindest Regards,


John

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