APPENDIX 18
Memorandum by Dr Johnson Ajayi (MS 24)
I have just received my latest copy of the Obstetrician
and Gynaecologist, the quarterly newsletter by the Royal College
of Obstetricians and Gynaecologists in which I read that the Parliamentary
Health Committee's Maternity Services Subcommittee will shortly
be undertaking an inquiry into the provision of maternity services
in England. Amongst others, you will be looking at the issue of
caesarean section rates.
I am a Member of the RCOG. I have personally
performed over 1,000 caesareans, and I work full-time at the Southport
& Formby District General Hospital. I am currently writing
a dissertation on the Legal Aspects of Caesarean Section
for the degree of Master of Law at the University of Cardiff Law
School under the supervision of Professor Viv Harpwood after taking
a a two-year part-time course on Medical Law. One of the chapters
in my current work is devoted to the rising rate of caesarean
sections in the UK, the causes of the rise and the financial and
planning implications. Caesareans are more expensive than natural
deliveries and each percentage rise of the current rate of 21%
(National Sentinel Caesarean Section Audit Report, 2001) costs
the Department of Health approximately £5 million a year
(Audit Commission, 1997). With inflation, the current figure must
be in excess of this.
In the UK we can aim to reduce the primary
(first) caesarean section rate by addressing the largest four
groups of women that contribute 70% to all caesars: failure to
progress in labour, fetal distress, breech presentation and previous
caesarean sections.
The United States have managed in the past five
years to reduce their all-time high rate of 27% to 22% principally
by addressing just one of these four groups of women—those
who have had a previous caesarean. Vaginal Birth After Caesarean
(VBAC) is now widely encouraged and is yielding dividends.
There are other reasons that I have identified
as contributing to the rising rates in the UK. I am also beginning
to audit my hospital's caesarean operations between 1997 and 2001
inclusive to identify their indications, and propose what we can
do to bring down our rates without compromising our standards.
It has been shown anyway that increased C/S rates do not necessarily
lead to a fall in perinatal mortality rates.
February 2003
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