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

2. 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

3. 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

4. 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

5. 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

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

7. 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?

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

9. Any Questions or Comments?
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