Caesareans ‘much more dangerous than was realised’ Infection risk makes them last resort, say midwives
23:45 GMT, 31 July 2012
The rate of caesarean births has doubled since 1990, and now accounts for almost a quarter of all births
Caesareans should be carried out only when absolutely necessary because the risk of infection is so high, experts have warned.
A study found that one in ten women develops an infection with many needing to stay longer in hospital for treatment.
Not only are these complications distressing for the mother, researchers warn, they also disrupt her ability to care for her baby.
Leading midwives said that for these reasons, caesareans should be carried out only where there is ‘high clinical need’.
But only last year the NHS relaxed its guidelines to allow women to have planned C-sections if they are particularly anxious about giving birth naturally.
Previously they were only meant to have the operation when it was medically justified.
Circumstances would include women expecting twins or triplets or those with high blood pressure or diabetes which meant that a natural birth would be high risk.
Latest figures show that almost a quarter of babies are now delivered via C-section, up from just 12 per cent in 1990.
Some experts say doctors are now far more willing to perform the procedure even when there is no good medical reason.
Researchers from the Health Protection Agency and Imperial College London studied 4,107 women who had undergone the operation in 14 NHS trusts between April and September 2009.
They found that 394 women developed an infection – 9.6 per cent.
Dr Catherine Wloch, from the Department of Healthcare Associated Infection and Antimicrobial Resistance, at the HPA said: ‘These infections are likely to have an impact on a woman’s experience and quality of life.
‘Although most caesarean section wound infections are not serious, they do represent a substantial burden to the health system, given the high number of women undergoing this type of surgery.
‘Minor infections can still result in pain and discomfort for the woman and may spread to affect deeper tissues. The more serious infections will require extended hospital stays or readmission to hospital.
‘Prevention of these infections should be a clinical and public health priority.’
Gail Johnson, education and professional development advisor at the Royal College of Midwives, said it was essential the operations were only performed where ‘clinically indicated’.
NHS guidelines have been relaxed so women can be offered a C-section if they are worried about the pain of giving birth naturally
‘Women who develop an infection postnatally are likely to feel less able to provide care to their baby and will take longer to recover from the birth,’ she said.
‘There’s a tendency to think that caesareans are completely safe but we’re talking about major surgery.
‘They should only be used when there is a risk of harm to mother or baby with a normal delivery.
‘It impacts a woman’s overall recovery and it may also impact on future pregnancies.’
She added that if the infection spread to the womb, the scarring may make it harder for a woman to conceive. In November, the NHS watchdog NICE relaxed its guidelines and said women should be offered C-sections if they were worried about giving birth naturally.
As many as one in ten expectant mothers suffer from a fear of childbirth which is known as tokophobia.
For some it is just an irrational phobia, but in others it is triggered by a previous traumatic labour.
Under the national guidance, women who request a caesarean because they are anxious will first be offered counselling.
If this fails to allay their fears, they will be allowed to have the operation.
A planned caesarean costs the NHS an average of 2,369, while a natural birth costs 1,665.
The latest study, published in BJOG, An International Journal of Obstetrics and Gynaecology, also found that obese women or those with diabetes were more likely to suffer from infections after a C-section.
Academics also think the risks are lower when a consultant surgeon performs the operation – rather than a lower-ranking medic – but they could not prove this in their study.