Intended for healthcare professionals


Caesarean section rate in England and Wales hits 21%

BMJ 2001; 323 doi: (Published 27 October 2001) Cite this as: BMJ 2001;323:951
  1. Roger Dobson
  1. Abergavenny

    More than 1 in 5 births in England, Wales, and Northern Ireland are now delivered by caesarean section.

    A national audit of the caesarean section rate, based on a snapshot of births in maternity units during a three month period, has shown that the overall rate for England and Wales is now 21.5% That compares with a rate in England of 4% some 30 years ago.

    The national sentinel caesarean section audit, carried out by the clinical effectiveness support unit of the Royal College of Obstetricians and Gynaecologists, also shows wide regional differences.

    Caesarean section rates were highest in Wales (24.2%) and lowest in the north east of England (19.3%) and the south west of England (19.4%). The rate for Northern Ireland was 23.9% There were regional differences too within the units.

    The report said that for maternity units with an annual delivery rate of more than 1000 babies there should be at least 40 hours of consultant time dedicated to the labour ward. But it says that this was achieved in only 16% of units in England, Wales, and Northern Ireland. A regional breakdown shows a wide variation, ranging from Wales having no units meeting the criterion, to the West Midlands with 29.4%.

    The audit said that there have been public health concerns for 30 years about the increasing caesarean section rate. It pointed out that the greatest increase in the rate in England was in the 1970s, when it doubled from 4% in 1970 to 9% by the end of the decade. By 1995, the rate was estimated to be 16% and in 1999 to be 19% The report noted that in Scotland the rate increased from 5% in 1970 to 20% in 1999.

    As well as providing what it described as the most comprehensive set of data collected on caesarean section rates, the report also gave insight into current views of consultants.

    As part of the exercise, 162 consultants from 40 units responded to a questionnaire. “Many consultants regard a CSR [caesarean section rate] of 20% as being too high,” said the report. “All but two consultants said that they believed there was a shift in obstetric culture towards a lower threshold for performing CS [caesarean sections].”

    The report also said, “Fifty one per cent thought that their unit rate was too high. The median CSR in units where these consultants were based was 23.1% Twenty one per cent of consultants reported that a high CSR did not concern them.”

    Factors associated with caesarean section rates included demographic changes, women's choices about childbirth, and the views of obstetricians.

    The National Sentinel Caesarean Section Audit Report is accessible at

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