Caesarean births increasing

Twenty-eight per cent of all births in Malta in the first quarter this year were by emergency or elective Caesarean section, an increase of four per cent over the same period last year, according to the latest National Obstetrics (NO) Report.

Though the figure is way above the recommended rate of Caesarean sections given by the World Health Organisation, there was absolutely nothing abnormal, according to Professor Mark Brincat, director of Obstetrics and Gynaecology.

The NO report states that in the first quarter of this year, 69 per cent (653) of births were delivered by vertex (normal) delivery, and three per cent (32) by assisted vaginal delivery.

When comparing the method of birth to last year's first quarter, the rate of births by vertex deliveries decreased by three per cent and the births by assisted vaginal delivery decreased by one per cent.

Caesarean births are becoming much more common over the world and the jury is still out over whether this is a good thing.

By the 1980s just 10 per cent of births were by C-section in the UK. The most recent National Sentinel Caesarean Section Audit Report, carried out in 2001, showed that 24 per cent of all births in Wales were Caesarean. The Royal College of Midwives estimates that the national rate last year was 22.3 per cent.

Internationally, Northern Ireland had a rate of 23.9 per cent in 2001, while the US had a rate of 22 per cent in 1999.

The WHO puts the acceptable rate of Caesarian sections at ten to 15 per cent for countries in the developed world. But Professor Brincat noted that the WHO took into consideration all countries, including those where Caesarian sections were still considered to be a high risk.

Professor Brincat said the rate of Caesarean births in a number of developed areas in Europe and the US was up to 50 per cent.

He said another important factor to consider was that half of all women who had one C-section were very likely to give birth that way again.

Professor Brincat admitted that C-sections were still shrouded in misconceptions. Some still think that specialists urge prospective mothers to opt for this system simply because of convenience. This was "certainly" not the case, he said.

He said a number of other factors lead to the need for Caesarean births.

No less than 12.5 per cent of Maltese babies weigh over 3.75 kg at birth, well above the UK average of 2.5 kg. Coupled with the fact that the Maltese are in general a short generation and taking into consideration the high incidence of diabetes, the need for C-sections increases, Professor Brincat explained.

More women were also choosing to have babies at a later period in life. The average age of childbirth is now 28. Also, several women were taking treatment for infertility.

"We have excellent natal facilities and treatment in Malta. We are capable of dealing with all high risk cases and will not take any risks, even if marginal. So much so, that the mortality rate during childbirth is down to a minimum," he stressed.