The changing incidence of caesarean section in the Health District of Central Manchester

Abstract

The caesarean section rate in England and Wales has practically doubled from 5.6% in 1974 to 10.6% in 1982. Because most statistical reports are based on the practice of individual hospitals and do not reflect what is occurring in a particular community, a retrospective study of the incidence of, and reasons for, caesarean section performed in residents of the geographically defined Health District of Central Manchester was carried out for 1974 and 1982. The caesarean section rate in this community increased from 7% in 1974 to 16% in 1982. Caesarean sections performed for (i) failure to progress in labour, (ii) previous caesarean section and (iii) preterm fetal compromise before labour accounted for three quarters of the increase. Breech presentation was not a significant contributor to the increase. The reasons for the increase in caesarean sections performed for failure to progress in the first stage of labour were not clarified in the records, and is the subject of prospective investigation.

Failure to progress in the management of labour

“…It has been suggested that the occurrence of prolonged labour in nulliparous women could be virtually eliminated by adherence to the principles of active management (Duignan 1985), and that the incidence of caesarean section could be dramatically reduced (Philpott & Castle 1972a, b; O'Driscoll & Meagher 1986; Turner et al 1988). However, despite widespread adoption of active management regimes, trends show that caesarean section rates are rising, the greatest increase being due to failure to progress in labour (Neuhoff et al 1989; Schifrin & Cohen 1989; Kiwanuka & Moore 1987)—the problem that active management was intended to address.…”

Magnetic resonance imaging pelvimetry: a useful adjunct in the management of the obese patient

“…The case presented highlights, as do many others, the problems experienced in obstetrics today, namely, an increasing proportion of caesarean sections being performed for failure to progress in the first stage of labour without clear evidence of cephalo‐pelvic disproportion or aberrant mechanisms (Kiwanuka et al 1987). Furthermore, many women undergoing caesarean section for failure to progress deliver normally in subsequent labours, as did this woman.…”

The rising caesarean section rate: A loss of obstetric skill?

“…If the membranes rupture early and there is a hind water leak, do not induce labour but manage conservatively with prophylactic antibiotics. If the baby is thought to be small, a distinction should be made between those who have IUGR and the small normal baby (Kiwanuka and Moore (1987).…”