Caesarean sections

This week's BMJ considers data on unnecessary caesarean sections. Trends show an increase, with rates reaching more than 50% in some Latin American countries. There are many suggested reasons for this rise—obstetricians' fear of litigation, consumer demand, and, as Béhague and colleagues show in their paper (p 942), to avoid poor labour care.

Caesarean operations, as they were known until about 400 years ago, are one of the oldest procedures. www.nlm.nih.gov/exhibition/cesarean/cesarean_1.html gives an overview of their history. The origin of the word is widely believed to be derived from the supposed method of delivery of Julius Caesar, but the site dismisses this, saying that it is more likely to come from the Latin verb “caedare,” meaning to cut.

For good, straightforward, and objective information on caesarean sections, www.childbirth.org/section/CSFAQ.html, www.babycentre.co.uk/refcap/160.html, and www.babyworld.co.uk/information/birth/cesarean/cesarean_birth.asp are all worth a visit. They are patient centred and provide answers to frequently asked questions. What is a caesarean, when is it needed, the risks of the procedure, types of anaesthesia used, and the risk of vaginal delivery after a previous section are some of the topics covered. These sites would help to allay women's fears of the operation, while remaining pragmatic about the risks.

Many sites discuss the increasing numbers of caesareans performed across the world, but I was surprised to find no specifically “anti-caesarean section” site. The closest thing was the site of the Association of Radical Midwives (www.radmid.demon.co.uk/). This warns that current practice goes against the evidence—much the same as the sentiments in one of this week's editorials (p 928). This site also contains personal stories, good and bad, from women who have had caesareans.

I was also surprised not to find many sites offering private sections for the “too posh to push” brigade. The only one I found was based in Solihull at www.wheresthis.co.uk/patient%20information/LUSCS.htm. The undisclosed fee included a six week check, but you probably won't see the surgeon before the operation.