Irish research shows that the increasing use of caesarean section in Ireland reflects a worsening risk profile for mothers

Conference brings together leading thinkers in the field of maternal health

A conference taking place at the ESRI on Tuesday 25th October will bring together leading researchers and practitioners in the field of maternal health to discuss the increasing use of caesarean section in Ireland and the associated risks for mothers and infants. The conference will discuss recently published and ongoing research from a collaboration between researchers from the ESRI, the Department of Sociology, Trinity College Dublin and the UCD Centre of Human Reproduction at the Coombe Women and Infants University Hospital.

The proportion of births delivered by caesarean section (CS) is increasing across OECD countries and Ireland is no exception. Here the proportion of births by CS has increased from 7% in 1984 to 13% in 1993 and 30% by 2014 (the latest year available). The option of using CS is a major reason why deaths among mothers and children in childbirth are a fraction of what they were in the past. Still, there are now concerns that the benefits of CS may be outweighed by the increased clinical risks and economic costs that it carries.

Joint research between the ESRI, TCD and UCD has investigated the factors driving the increasing use of CS using data on births recorded in the 19 Irish maternity units over the last 17 years. By focusing on variation in the use of CS across units, the researchers sought to understand what clinical and sociodemographic factors are driving the CS trend and thus contribute to the development of safe and cost-effective services for mothers and babies.

The primary reason why use of CS has increased over time is that medical advances have made the operation much safer for the mother but the research also shows that factors like the increasing average age of mothers, particularly first time mothers and the clinical risks that this brings are crucial. The research also shows that maternity units still vary in the use of CS after the characteristics of mothers have been accounted for.

Research findings from the joint research initiative:

  • In 1984 just 7% of deliveries were by CS. This was 13% in 1993 rising to 30% by 2014, a fourfold increase in 30 years.
  • Ireland’s CS rate is average to high within the OECD where countries like the Netherlands have rates almost 50% lower than Ireland. Italy has the highest rates of CS in Europe.
  • The average age of mothers has increased from 30 in 1999 to 32 in 2014.
  • The proportion of births to women aged 35 plus has increased from 20% in 1999 to 33% in 2014, a 65% increase.
  • The proportion of first births in the total decreased from 41% in 1999 to 39% in 2014.
  • The proportion of mothers with high blood pressure (including pre-existing) increased from 3.7% in 2005 to 4.4% in 2014.
  • The proportion of mothers with gestational diabetes increased from 1.3% in 2005 to 5.5% in 2014.
  • Use of vaginal birth after CS has fallen significantly over time.
  • Overall variation across maternity units in proportion of births by CS has fallen since 1999 but the absolute difference between the units with the highest and lowest rates has increased. Units with high proportions in 1999 have increased the most.
  • After adjusting for the risk profile of mothers, significant differences remain in the likelihood of a woman experiencing CS across maternity units in Ireland.

Policy Implications

  • The number of births in Irish maternity units increased from 54,000 in 1999 to over 76,000 in 2009 before falling to 68,000 in 2014, a 26% increase.
  • The average level of risk associated with mothers giving birth in Irish hospitals is increasing.
  • However, funding and staffing levels in maternity services has not kept pace with either the number of births or the risk profile.

Prof Michael Turner (UCD Centre for Human Reproduction) commented that:

“Although many of the obstetric trends in Ireland are challenging, Irish maternity units continue to deliver results which are among the best in the world. If we wish to maintain this record we will need to invest to take account of adverse trends whilst constantly striving to coordinate and improve practice in Irish maternity services.”

Prof. Richard Layte, (ESRI and Department of Sociology, TCD), added:

“For the first time, this conference provides a platform for multi-disciplinary experts in this field to share their expertise in relation to the most recent findings, with the objective of facilitating dialogue that advances and supports evidence-based policy in healthcare.