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Background: Obstetric units across the UK face resource pressures alongside a rising rate of Caesarean section (CS). It is assumed that this places a further burden in the form of postnatal bed demands. The number of inpatient beds has fallen nationally, and this may be used to justify attempts to restrict the CS rate. We set out to replace such assumptions with evidence. We did not find any similar contemporary analysis in a literature search., Methods: The postnatal length of stay (LOS) of women delivering at Watford General Hospital, a large unit hosting around 5500 deliveries per annum, was stratified by mode of delivery. Differences within and across time periods were analysed., Results: The CS rate rose from 14.5% in 1995 to 30.9% in 2015. The mean LOS post-CS declined from 4.2 to 2.4 days. These data were statistically significant to p < 0.001. Over this period the standardised total postnatal bed use for all delivery modes fell from 11083 days to 7894 days. A 113% rise in the CS rate was accommodated by only a 19.8% rise in postnatal bed use attributable to CS patients., Conclusions: Whatever pressures may be exacerbated by the rising CS rate, bed occupancy is not one of them. In discussion we widen our argument to suggest that resource pressures should not be used to justify limitations in the CS rate. more...

A retrospective study over a 6-year period was undertaken to determine the trend in age at booking for antenatal care at West Hertfordshire Hospitals NHS Trust and to investigate the relationship between maternal age at booking for antenatal care and mode of delivery. Between 2006 and 2011, there was an 80% increase in the number of women over the age of 40 years booking for antenatal care. The overall caesarean section rate in this cohort of women increased from 34.6% in 2006 to 53.7% in 2011, comprising of an increase in both elective and emergency caesarean sections. It appears that increasing maternal age may explain a significant proportion of the rising caesarean section rate in our unit. more...

In a study between 1 January 1996 and 31 December 1998 at Watford General Hospital, we identified all women who booked having had a previous caesarean section. Data on age, social class and previous obstetric history was extracted from the notes, as was mode of delivery. Of the 718 patients identified, 497 were considered suitable for trial of scar. Of these 221 (44·5%) requested repeat caesarean section. Age, social class and indication for previous caesarean section could not predict those who accepted trial of scar. Of the 60 women who had had a previous successful trial of scar 59 (98·3%) underwent trial of scar and of the 48 who had had a vaginal delivery prior to caesarean section 37 (77·1%) underwent trial of scar (P < 0·01). Maternal request for caesarean section, without obstetric contraindication to trial of scar, accounted for 24·9% of all the elective caesarean sections undertaken in our unit. [ABSTRACT FROM AUTHOR] more...

At a time when there is much criticism of increasing caesarean section rates, as well as an increased emphasis on involving the patient in decisions regarding her care, we decided to assess the effect of maternal request on the elective caesarean section rate. The study was a prospective patient interview and case note review, set at a District General Hospital in Watford, Hertfordshire over a 1-year period. Eligible patients included all women undergoing elective caesarean section, with the main outcome measure being the number of elective caesarean sections performed without obstetric contraindication to vaginal delivery. Out of 3025 deliveries, 570 (18.8%) were delivered by caesarean section, 276 (9.1%) electively and 293 (9.7%) as an emergency procedure. Of the elective procedures (18.2% of the total number of operations), 38% were performed because of maternal request. We conclude that maternal request is a significant factor in the rise in caesarean section rate. [ABSTRACT FROM AUTHOR] more...

To assess whether maternal request for elective caesarean section was in fact obstetrician driven a postal questionnaire was undertaken in the North Thames Region. One hundred and thirty-four consultants who undertook NHS obstetrics replied to the questionnaire. Only one (0·8%) offered elective caesarean section to all women, and all suggested trial of scar in selected cases. Eighty-three (61·9%) of respondents felt that maternal request had significantly increased their caesarean section rate. It is concluded that maternal request for caesarean section is not obstetrician led, but patient driven. [ABSTRACT FROM AUTHOR] more...

Presents an obstetric case report about a post morterm caesarean section performed on a 38-week pregnant woman. Subjective information on the patient; Discussion on the treatment and outcome.

The article presents abstract related to the increased in the cesarian delivery rates. It investigated on the involvement of patient in the decision making in terms of the most convenient and safest way to deliver the child. The study revealed that 38 percent of the elective cesarian sections were performed mainly out of the requests of the mothers. more...