More obstetricians could reduce caesarian births

LONDON, Sep 22 (Reuters) Increasing the number of skilled obstetricians could help to reduce the incidence of caesarean births, researchers today said.

Rises in elective caesarean deliveries have been widely reported but the increasing number performed during the second stage of labour has drawn little attention, said Chris Spencer a senior obstetrician at St John's Hospital, Chelmsford.

''Although second stage caesarean section is sometimes appropriate, many could be prevented by the attendance of a more skilled obstetrician,'' Spencer added in an editorial in the British Medical Journal.

Caesarean section is usually performed when a natural birth is not possible because of prolonged labour, failure for labour to progress, maternal or foetal distress, complications, multiple births or other problems.

Spencer and his colleagues cited a recent British study that showed that if senior obstetricians assessed a woman during labour they were likely to reverse a decision for a caesarean delivery made by a less experienced obstetric trainee.

About 35 per cent of caesareans for single births in Britain are done because the woman's labour fails to progress. In 55 percent of those cases there was no attempt at a natural birth using instruments such as forceps or suction to deliver the baby, according to figures released by the Royal College of Obstetricians and Gynaecologists.

In twin births, the researchers said 10 per cent of second twins are delivered via Caesarean section after the first twin has been born naturally. This is double the rate of 10 years ago.

Spencer and his colleagues said Britain is making progress in training obstetricians.

''Nevertheless, it is essential to recognise the need for obstetricians to maintain and develop their skills if women are to be offered safe alternatives to caesarean section when complications arise in labour,'' they added in the journal.

REUTERS SY BS0902