Max Brinsmead MB BS PhD May 2015 Why so many Caesareans? Max Brinsmead MB BS PhD May 2015

Caesarean Sections are Popular because: Caesarean Section is Convenient Caesarean Section is Simple Caesarean Section is Safe Caesarean Section is “Better for Babies”  When you have done a Caesarean you have done everything possible – the medicolegal imperative

Caesarean Sections are Popular because: Vaginal Birth is Painful Vaginal Birth is Unpredictable If there is a 1:3 or even a 1:5 chance of requiring a CS why not just do one? “Vaginal Birth Ruins your Sex Life” There is no evidence for this And the contrary may be true “Vaginal Birth Destroys the Pelvic Floor” Risk of urinary incontinence rises 1.6 –fold But only exclusive CS will prevent that and... 40% of parous women will have incontinence in later life regardless of mode of delivery

Caesarean Sections are more common because: “Once a Caesarean always a Caesarean” The Term Breech Trial Fewer difficult Forceps and Ventouse Loss of obstetric skills Pressures on Medical Resources

Caesarean Sections occur when: Fetal distress is diagnosed by CTG There is concern about transmission of an infection e.g. Herpes, Hep C, HIV There are medical problems and non obstetricians are involved e.g. diabetes, back pain, epilepsy Patients are privately insured GPs and midwives compete with specialists

Caesarean Sections have increased because: The Power of Choice Fathers have influence It is Fashionable Reduced Family Size

Caesarean Sections are increasing because: There is an obesity epidemic Maternal age is increasing Epidurals sometimes fail Induction of labour sometimes fails An epidemic of sexual abuse?

Caesarean Sections are increasing because: “My mother and my sisters all had Caesareans” “This is an IVF baby” Evolution of the species?

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