Why doctors give caesarean sections: Nearly 70 per cent choose the procedure out of fear of being sued, reveals study
- Doctors may choose a c-section because they think it is safer than vaginal birth
- But they may also be motivated by a lack of resources or because it is ‘organised’
- Experts say c-sections are being performed ‘without justifiable reasons’
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Nearly 70 per cent of doctors who deliver babies by c-section may do so because they are afraid of being sued, a study has revealed.
A review of past studies gives and insight into the reasons why obstetricians perform caesarean sections, in which a baby is surgically cut out of a woman’s womb.
As well as fear of litigation, doctors have said they choose c-sections to avoid damage to the woman’s body or because there are not enough staff to allow a vaginal birth.
Doctors may also prefer a c-section because it is more ‘convenient’ and ‘organised’, and senior medics are more likely to be in favour of the procedure.
And this is despite there being evidence that natural vaginal births are actually safer and less likely to have complications.
Experts say it is important to understand a concerning trend of doctors opting to operate, and one says they often do it ‘without medically justifiable reasons’.
Around a quarter of women in the UK and a third of those in Ireland give birth by c-section, but experts are worried doctors might be doing them ‘without medically justifiable reasons’
The research by Trinity College Dublin inspected 34 scientific studies about doctors’ attitudes to caesarean sections in 20 countries around the world.
One study in the UK and Ireland revealed fear of legal action was a reason to perform a c-section for 67 per cent of obstetricians.
Most of this fear was of legal consequences of complications during vaginal birth if they did not perform the c-section, according to the research, even though a natural birth is often safer.
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Around a quarter of women in the UK and a third of those in Ireland give birth by c-section, and researchers were keen to understand why.
The procedure is usually only carried out if it is safer for the mother and baby than a natural birth, according to the NHS.
It carries a risk of infection, bleeding, damage to internal organs, breathing problems for the baby, or accidentally cutting the baby.
Doctors may overestimate how risky a natural birth is
Doctors’ beliefs accounted for a lot of the reasons they opt to deliver babies by c-section, the research found.
This included the obstetricians’ personal views on c-sections, over-estimating how risky a vaginal birth is, and considering a caesarean to be a safe and convenient option.
WHAT ARE THE MEDICAL REASONS FOR A CAESAREAN?
There are various reasons why a doctor may recommend that you have a caesarean section instead of giving birth vaginally.
If you had complications in a previous pregnancy or birth, or in your current pregnancy, you may be advised to have what’s called a planned or elective caesarean, or a planned repeat caesarean.
If you were planning to give birth vaginally, but complications during labour or birth mean that you’re advised to give birth by caesarean, you’ll have what’s called an unplanned or emergency caesarean.
Here are some reasons why doctors may opt for a planned or emergency caesarean, rather than a vaginal birth:
- You’ve already had at least one caesarean section.
- Your baby is in a bottom-down, or breech, position.
- Your baby is in a sideways (transverse) position, or keeps changing its position (unstable lie).
- You have a low-lying placenta (placenta praevia).
- You have a medical condition, such as heart disease or diabetes.
- You have lost a baby in the past, either before or during labour.
- You’re expecting twins or more.
- Your baby is not growing as well as it should be in your womb.
- You have severe pre-eclampsia or eclampsia, making it dangerous to delay the birth.
Source: BabyCentre
Medics also say they would do one to avoid causing incontinence or a vaginal prolapse after a natural birth.
‘Caesarean section rates are increasing worldwide’
The study’s author, PhD student Sunita Panda said: ‘Caesarean section rates are increasing worldwide, particularly among first-time mothers, with limited explanation of the factors that influence the rising trend.
‘This is a big concern for health care professionals because vaginal birth is safer and associated with fewer complications.
‘Our research gives important insight into the ‘why’ behind the rising rate of caesarean sections.
‘Our study identified the significant influence of fear of litigation on clinicians’ decision to perform caesarean sections, irrespective of hospital setting, age, gender, professional experience, resources and culture within the health care system.’
The research suggested being able to control the labour is appealing to doctors, who might otherwise have to wait through day and night for a natural birth.
Some medics ‘intervene prematurely’
Avoiding conflicts between staff in the delivery room is also cited as a reason for choosing a c-sectionm as is potential financial benefit for private hospitals.
Dr Deirdre Daly, who supervised the study said: ‘It is really important to understand these factors because they influence individual clinicians’ attitudes towards the natural progress of labour and spontaneous birth, even when the woman and baby are well and have no risk factors.
‘This then leads to the decision to intervene prematurely, often without medically justifiable reasons.’
And collaborator Professor Michael Turner added: ‘If we are to reverse this trend nationally, we need to better understand the complexity of the decisions made by women and their obstetricians.’
The researcher Ms Panda reviewed 34 studies involving 9,008 midwives and obstetricians between 1992 and 2016.
Her findings were published in the journal PLOS ONE.
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