Coombe Caesarean
birth rate rises to 18.9%
By Alison Healy

The Coombe Women's Hospital recorded a small but continued rise in its rate of Caesarean sections last year, with the surgical procedure now accounting
for almost one-fifth of deliveries.

Some 18.9 per cent of births were by Caesarean section at the Dublin hospital last year, compared with 18.7 per cent in 2001. However, five fewer first-time mothers had Caesarean sections last year.

Apart from a temporary blip in 1997, the percentage of mothers having Caesarean sections has continued to rise from a rate of 14.1 per cent in 1995.

The figure is published in the Coombe's annual clinical report, which notes the increase but says it is "relatively slow by international standards".

Most maternity hospitals have seen an increase in Caesarean section rates in recent years, with obstetricians citing the growing threat of litigation and an increasing demand from patients for the surgery. Fear of childbirth has been quoted as one reason for the procedure, in what has been dubbed the "too posh to push" syndrome in Britain.

The World Health Organisation recommends a rate of 15 per cent but a 1999 study found that the average rate in Irish hospitals was 20 per cent.

A 1998 survey of maternity hospitals conducted by Cuidiú, the Childbirth Trust, found the greatest percentage of Caesareans were performed at St Luke's Hospital, Kilkenny (25 per cent). Other hospitals confirming high Caesarean rates at that time included St Munchin's, Limerick (24.58 per cent) and Cavan General Hospital (24 per cent).

The Coombe report also showed that the hospital had the lowest corrected rate of stillbirths and neo-natal deaths ever recorded among the three Dublin maternity hospitals last year.

The rate of 4.8 perinatal deaths per 100,000 babies excludes congenital malformations and compares with a figure of 6.7 deaths per 100,000 five years ago.

Of the 7,507 infants that were delivered by Coombe staff last year, 58 did not survive - 32 were stillbirths, 24 died soon after birth and two died within three weeks of birth. Most of the deaths were caused by congenital malformations and prematurity.

For the first time in three years, the Coombe recorded the death of one mother last year. The 30-year-old African woman was HIV positive and died while receiving a liver transplant in a general hospital.

Her premature baby was delivered by Caesarean section and was alive and well, according to the hospital.

Of the 82,879 mothers who attended the Coombe Hospital in the past 10 years, six died in direct or indirect obstetric deaths.

One in five mothers giving birth last year was from overseas, according to the report.

After Irish women, African mothers accounted for the second-largest nationality last year, making up 5.32 per cent of patients. This was a drop of almost 2 per cent on the previous year. British women accounted for 5.25 per cent of patients while 3 per cent of mothers were from non-EU countries, including Russia.

Recruiting staff and retaining midwives continued to be a major problem for the hospital last year, according to the Master of the Coombe, Dr Seán Daly.

"We again experienced ongoing difficulties with staff recruitment and the exodus of midwives, particularly to the public health service, continues to be a problem," he wrote in the report.

© The Irish Times