Northern Ireland news

Caesarean section rates in NI hospitals remain highest in NHS

Caesarean deliveries remain highest in Northern Ireland hospitals compared with the rest of the UK
Seanín Graham

CAESAREAN sections in Northern Ireland hospitals remain the highest in the NHS despite a six-year drive to reduce them, a watchdog report has warned.

More than half of 'c-sections' in the north's maternity units are planned and carried out before labour, with the Southern health trust having the highest rate of caesareans - 34.5 per cent compared to the UK average of 25 to 26 per cent.

A report carried out by the Regulation and Quality Improvement Authority (RQIA) into a strategy aimed at improving maternity care between 2012 and 2018 said the reason for the high number of caesareans is unclear.

"The difference is most marked for elective (planned) caesarean sections. Between 2008-2009 and 2013-2014 the percentage of caesarean sections has remained fairly constant at between 28% to 30%, compared to 25-26 % in other parts of the United Kingdom," according to the report.

"The exact reason for this is not known but a caesarean section in one pregnancy can lead to more complications in later pregnancies."

Caesarean sections cost the health service almost twice that of a normal delivery - £3,724 compared to £1,933.

Two years ago, the north's audit office raised concerns around the practice, questioning if the number of sections were clinically necessary or were being carried out because 'staff were not available to cover long labours'.

The latest RQIA probe into maternity provision investigates all sectors of the health service and how they have responded to calls for an overhaul of services.

Overall, the watchdog commends the work of each health trust and were impressed with a 'can do attitude', particularly in areas of community based work and attempts to improve midwifery-led care.

But they warned of a number of key areas where concerns remained, with particular problems around staffing and the impact of relying on locum doctors and the increase in midwives retiring.

The watchdog was especially critical of GPs - and the lack of training in antenatal care.

"In the last 10 years there has been a shift in GP training with GPs having little or no obstetrics training. As part of their contract, GPs are required to provide antenatal care. However, this is rarely undertaken within General Practice unless there is a community midwife in the practice. This is further demonstrated by the lack of or inappropriate use of antenatal growth charts," the report warns.

Other issues flagged by the watchdog included:

- Mental health services for 'at risk' pregnant women remain a challenge. Northern Trust have no specialist service. Calls for a NI network to be set up

-Transfer of women deemed to have 'low-risk' pregnancies from Midwifery Led Units (where there is no consultant) who develop complications and must be transported to bigger hospitals. The ambulance service say there are 'challenges' around this

-Pressure to discharge women from hospital within a shorter time after giving birth has led to an increase in readmissions of some newborns to neo-natal units. The RQIA has called for an audit of these cases

Olive Macleod, RQIA's Chief Executive, said: “RQIA found that significant work has been undertaken to progress the strategy, and while there is good support for its implementation, further work is required to fully deliver its objectives.

"This review makes 19 recommendations to support improvement in the implementation of the maternity strategy. Key recommendations include: reviewing the transfer arrangements for women between midwife-led units and consultant-led units; consideration of consultant obstetrician and anaesthetic cover in labour wards; and greater clarity around the role of GPs in supporting women making informed choices about their care, including referral to midwifery led units."

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