What are the caesarean rates in my country?

Understanding the caesarean rate in your country, and specifically in the hospital where you are going to give birth, is really useful when devising your birth plans.

Like it or not, the preferences and beliefs of those assisting with your birth are going to play a part in the advice you are given as your vaginal birth progresses.

Planning a vaginal birth, is just that – a plan – it is not a guarantee. So knowing a bit more about the conditions under which you may need to negotiate is going to be an important factor in the outcome and knowing the rates plays a part in this.

Let’s take the UK as an example. The caesarean rate has been 1 in 4 for years. In 2018 it climbed slightly – getting nearer to 1 in 3. However, if you look at the rates for individual hospitals in 2016, some were 1 in 3, others 1 in 5. So if you are hoping to avoid a caesarean and your hospital has a rate of 1 n 3 rate, you might want to know what it is that makes it different from one with a 1 in 5 rate. This knowledge is just as important if you are hoping to plan one.

Playing a large part in these differences are the policies and preferences of the clinicians and the hosptials they work in. You might be able to get a bit of an idea by asking the PALs (Patient Advice and Liason Service) team at your hospital for any information about the caesarean policy (non-medical electives may be strongly discouraged for example), any limits placed on the duration of 2nd stage labour and the VBAC policy etc. They may or may not show you this. So also talking to local antenatal support groups and other mothers who have already given birth in your hospital might give you a bit more information.

Unfortunately, despite an acknowledgement by the World Health Organisation that there is “no empirical evidence for an optimum percentage” for caesarean deliveries, some hospitals are still directing staff to drive down their caesarean rate. While this is often claimed to be for medical reasons, it is in no small part also a cost cutting exercise. Don’t get me started on the problems with this – suffice to say material used to support this claim are hugely problematic because they generally group all caesareans together and then compare their cost with natural, drug free births. The two are not comparable – an emergency caesarean does not have the same costs as a planned caesarean, and a medicalised vaginal birth is not the same cost as a natural birth. In fact the cost of a medicalised vaginal birth and an emergency caesarean are almost the same and only around 50% of planned vaginal births are entirely natural (NHS Information Centre 2008). Enough said.

Anyway, it is worth trying to at least work out what you are facing at your hospital as you make your plans. In particular, understanding what constitutes a recommendation versus a necessity when being asked to go ‘off plan’ and then having your opinion backed up with solid information will help you negotiate.