23% of babies in England are delivered by caesarean section

BMJ 2005; 330 doi: (Published 07 April 2005) Cite this as: BMJ 2005;330:806
  1. Susan Mayor
  1. London

    Rates of caesarean deliveries in England have increased slightly, according to figures published last week, which continued the long term trend of increasing medical intervention in child-birth. The NHS Maternity Statistics, England: 2003-04, based on hospital episode statistics, showed that the rate of caesarean sections increased slightly from 22.0% in 2002-3 to 22.7%. The total number of births also rose by 5% to 593 600 deliveries.

    Just less than half the caesarean deliveries (9.6% of all births) were planned, an increase of 0.3% from the previous year; the remainder were emergencies. One in eight women (12%) had instrumental deliveries. Only 46% of the total, an increase of 5% from 2002-3, were considered normal deliveries, defined as occurring without surgical intervention, use of instruments, induction, epidural, or general anaesthetic.

    The report noted that the proportion of women having a caesarean delivery had increased slowly from under 3% in the 1950s to 9% by 1980, and to 12% by 1990-1. The rate then increased more rapidly during the 1990s, reaching 22% by 2001-2 before rising slightly in the latest figures.

    Malpresentation of the fetus accounted for about a quarter of planned caesarean sections and 10% of emergency caesarean procedures. Induction of labour, which occurred in a fifth of women, was also associated with an increased rate of caesarean deliveries. Nearly one in five women (19%) whose delivery was induced by drugs went on to have an emergency caesarean section. A further 14% of women whose labours were induced had instrumental deliveries. In contrast, three quarters of deliveries were spontaneous in women whose onset of labour was spontaneous, 11% were instrumental, and 11% were by emergency caesarean section.

    Prolonged labour was also more likely to result in caesarean deliveries. Two thirds of women with prolonged first stage of labour had an emergency caesarean section, accounting for about 15% of all emergency caesarean deliveries.

    The report, NHS Maternity Statistics, England: 2003-04 is available at

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