Concern as c-sections in Irish maternity hospitals at double the rate elsewhere in Europe
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The rate of caesarean sections in many of the country's biggest maternity hospitals is now double that of Western Europe, a situation that has been described as alarming.
More than 40% of women who gave birth in eight Irish hospitals have had a caesarean section, sparking concern that c-sections are now becoming "the accepted norm".
An analysis of HSE data on births by first-time and repeat mothers across the country's 19 maternity sites shows that in five hospitals, over 50% of first-time mothers were having a c-section.
In a further six hospitals, the rate of c-sections for first-time mothers was between 40% and 49%.
Last year, there were more than 57,000 births registered in Ireland in total.
Dr Krysia Lynch, chair of maternity group AIMS Ireland, said the data was collated from maternity safety statements published by hospitals this summer, describing the figures as a snapshot of what is happening.
“I’m not trying to pick on particular hospitals, but a large number of units have very high rates,” she said.
"And that is alarming because it is not appropriate that so many people are having a medicalised surgical start to becoming a parent," she said.
The rates are high across many of the 19 units, she said.
“I think it is an unacceptable caesarean section rate for us to sustain in Ireland,” she said.
Eurostat figures for 2021 show Ireland, Romania, and Cyprus have the highest c-section rates in Europe, with the Irish rate more than double that of each of the three lowest countries.
This is echoed in World Health Organisation data for 2018, showing a rate of 24.2% across Western Europe.
The WHO said in 2021: “As countries increase their caesarean section rates up to 10%, maternal and neonatal mortality decrease.
“However, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.”
While a c-section is generally a safe procedure, it is still regarded as major surgery and normally has a long recovery time of six to eight weeks. There is also the potential for infection and other complications.
Dr Lynch, speaking at the AIMS Ireland AGM in Dublin, also highlighted high rates of induction to start labour across the 19 maternity hospitals.
She identified that between 50% and 55% of first-time mothers across six hospitals were induced and, at eight hospitals, the rate was between 40% and 49%, with four hospitals doing this for less than 39% of mothers.
“At three of our units over 50% of new parents were not going into spontaneous labour,” she said. “That is a very high statistic.”
She said it is noteworthy to see high rates both of c-sections and inductions as women are often told an induction makes them less likely to need a c-section.
The analysis found, however, that the data "does not bear that out for Ireland. And people should not be told that".
The meeting also heard from Dr Liz O'Sullivan, lecturer in nutrition at TU Dublin, about her research into breastfeeding rates.
She discussed findings showing that while many women experience positive breastfeeding support, others reported support was inaccessible or inadequate.
Another theme which emerged was that women felt breastfeeding support was there "in theory" but not in practice.
Research published with advocacy group Bainne Beatha, based on more than 5,000 responses, indicated particular challenges with weekend access to lactation support, she said.
Women reported getting conflicting advice and that access to support varied depending on which midwife was on duty at any time.
The AIMS event also heard that 25% of births in Irish hospitals last year were to migrant women.
Jane Xavier, a Brazilian social scientist and postnatal bereavement doula, discussed the challenges facing women of colour in particular.
She said these women have “greater difficulty in accessing healthcare services than their white counterparts”.
This can be down to cultural differences, language barriers, or lack of information, resulting in isolation, she warned.
She described her own pregnancy bereavements and said she felt “neglected” and “abused” during these experiences.
She called for more awareness of the challenges. This call was supported by perinatal psychologist Caroene Santos Murray, who has supported many migrant women in Dublin through difficult experiences.
“Being away from extended family and support networks can contribute to feelings of isolation, especially if there is a lack of understanding or acceptance within the new community,” she said.