Thursday 2 May 2013

Hospitals 'are ignoring advice on caesarean sections'

Hospitals 'are ignoring advice on caesarean sections': Some C-sections are being carried out too early, and babies face risk of serious breathing problems, say experts
The health of thousands of babies born every year by planned caesarean section is being put at risk because hospitals carry out the operations earlier than is wise, childbirth experts are warning.

In some hospitals, more than half of those who have the operation have it before the 39th week of their pregnancy, in contravention of official NHS guidelines.
Advice drawn up by the National Institute of Health and Care Excellence (Nice) says elective caesareans should not be performed until after 39 completed weeks so that the baby's lungs can develop fully. Otherwise, babies can suffer neonatal respiratory morbidity – serious breathing problems – which can prove fatal.
But a report out by the Royal College of Obstetricians and Gynaecologists, which represents the UK's 11,500 maternity doctors, reveals that the procedure is carried out before 39 weeks in 37% of such births in England and as many as 52.5% in some hospitals.
Official NHS statistics show that 10.2% of the 668,936 births in England in 2011-12 were by elective caesarean. It is often used to deliver a baby in cases where the woman has an underlying medical condition, had a previous C-section, or previously suffered birth trauma and does not want to go through a natural birth.
The RCOG's report says the overall proportion of elective C-sections performed before 39 completed weeks has fallen from 61% in 2000-01, but still stood at 30.3% (20,674 babies) in 2011-12.
Dr David Richmond, the RCOG's vice-president for clinical quality and co-author of the report, said the findings illustrated widespread variation between hospitals in childbirth practice and were a concern. "We don't want to create unnecessary illness in the baby, but in some cases that may be happening," he said.
A baby born by caesarean section has a 1.5% risk of neonatal respiratory morbidity if it is born at 40 weeks, but the risk rises to 2.1% at 39 weeks, 5.1% at 38 weeks and 10% at 37 weeks. Richmond said: "In some cases, babies with respiratory difficulty will have long-term complications, and some will die."
Most babies who develop the problem have to spend time in a special care unit, but some have such difficulty that they have to be ventilated in a neonatal intensive care unit. A mother's separation from her new baby, and the bonding issues that can create, and cost to the NHS of looking after such babies, were also reasons why the NHS should start following Nice's advice, added Richmond.
Belinda Phipps, chief executive of the National Childbirth Trust, said: "NHS practice on this is damaging and isn't helpful to babies. Hospitals' preference for doing so many elective C-sections before 39 weeks leads to morbidity and mortality in babies, because the babies' lungs aren't properly developed and so they stand a higher chance of being resuscitated and also of ending up in neonatal intensive care."
She said she was staggered to find that 52.5% of women having a planned C-section in certain hospitals did so before 39 weeks. Mothers-to-be were generally unaware of the risks for the baby and maternity staff should start explaining them and carry out the operation only in cases of medical need, such as ongoing serious pelvic pain.
Early C-sections happen because maternity units tend to try to reduce their workload around holiday periods such as Easter and Christmas, or because an obstetrician is going to be away just after the 39th week, or because "in the last few weeks of pregnancy, some women are so tired and uncomfortable that they just want their baby out of there. If the woman says that, and the obstetrician is away the next week, that's how it can happen," said Phipps.
The RCOG has not named the hospitals with the highest rates of early elective C-sections, but plans to do so when it repeats the exercise next year. It also uncovered very big differences between hospitals in how many mothers end up having their labour induced, undergoing an emergency caesarean or having their baby born by forceps or vacuum cups, which may indicate poor practice in some places.
Dr Dan Poulter, the health minister, who is also a practicing NHS obstetrician, said the report "shows our NHS how it can improve, and it will help raise standards for women and families right across the country. Our NHS is lucky to have many skilled and dedicated obstetricians and midwives looking after women before, during and after childbirth, and this report will help frontline maternity professionals to improve the care that they provide to women and their babies." The Guardian

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