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. 2001 Aug 4;323(7307):284.

High caesarean section rates among women over 30

Effect of age is continuous and international

John C Marwick 1,2, Robert Lynn 1,2
PMCID: PMC1120894  PMID: 11505940

Editor—Bell et al's finding that rates of caesarean section increase with age1 are similar to findings from our analysis of all 103 883 births in New Zealand hospitals between 1 July 1996 and 30 June 1998.2 Interestingly, our analysis shows that rates of caesarean section increase in a continuum from teenage years upwards: there was no age from which the increased likelihood of the operation first began to be noticed. Similar findings have been noted previously from, among other places, Britain,3 Jordan,4 and Italy.5

Our analysis shows that women who are having a repeat caesarean section explain some of the increase, but a steady increase is still present in women who have not had a previous caesarean section. Rosenthal and Paterson-Brown suggest that this may be related to physiological changes with increasing maternal age.3

The remarkably consistent finding from diverse countries about the effect of age led us to conclude that it is unlikely to be a result of clinical practice or societal pressures.

References

  • 1.Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, Hall MH. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. BMJ. 2001;322:894–895. doi: 10.1136/bmj.322.7291.894. . (14 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
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BMJ. 2001 Aug 4;323(7307):284.

High rates may be due to perceived potential for complications

Jane Weaver 1, Helen Statham 1, Martin Richards 1

Editor—Bell et al show that the higher caesarean section rate among older women is not entirely explained by their tendency towards more complicated pregnancies and births.1-1 They speculate that doctors' and maternal preferences might be contributory factors. An associated factor might be uncertainties related to the perceived potential for complications.

In a rapid response Quadros summarised the rising rate of caesarean section in just a few words: convenience and fear.1-2 As part of our research into women's choice and decision making in caesarean section we interviewed obstetricians and midwives, and women who had, or considered having, a caesarean section.1-3

Many obstetricians told us that the number of women who requested a caesarean section purely for convenience was comparatively low. In fact, the postoperative recovery period after a caesarean section is weeks rather than the days it usually takes to recover from normal birth. We found that although women might be unaware of the morbidity for mother and baby usually associated with caesarean section, they do generally know about its debilitating effect.

The issue of fear is more complex. Some women strongly fear childbirth,1-4,1-5 sometimes because of how pregnancy and birth are managed. In large obstetric units, women may have many investigations, with additional monitoring for potential problems. Such hypervigilance can make younger women think that birth must be risky. In older women it is assumed, a priori, that they may have a complicated birth, just by virtue of their age. The additional psychological stress of being considered high risk and, as a result, possibly being subjected to even more monitoring might underlie an unacceptable fear of both vaginal birth and things going wrong. This could lead both to requests for caesarean sections from women and to increased willingness to perform them among obstetricians.

Every caesarean section performed on an older woman will enter statistics that are often used to show that such women have more problems giving birth vaginally; they also become part of the culture of childbirth that instils fear of birth in other pregnant women. Thus fear perpetuates fear. Older women do have extra problems, but concern about complications might be as much of a problem as the complications themselves.

References

  • 1-1.Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, Hall MH. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. BMJ. 2001;322:894–895. doi: 10.1136/bmj.322.7291.894. . (14 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Quadros LGA. Convenience and fear [electronic response to Bell JS et al. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis]. bmj.com 2001. www.bmj.com/cgi/eletters/322/7291/894#EL2 (accessed 17 Jul 2001.) [DOI] [PMC free article] [PubMed]
  • 1-3.Weaver JJ. RCM Research Network. A study of choice and decision making in caesarean section. RCM Midwives J. 2000;3:77. [Google Scholar]
  • 1-4.Weaver JJ. Talking about caesarean section. MIDIRS Midwifery Digest. 2000;10:487–490. [Google Scholar]
  • 1-5.Statham H, Weaver J, Richards M. Why choose caesarean section? Lancet. 2000;357:635. doi: 10.1016/S0140-6736(05)71425-2. [DOI] [PubMed] [Google Scholar]

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