Why 'down under' is a cut above: a comparison of rates of and reasons for caesarean section in England and Australia.

Journal article

BACKGROUND: Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point. METHODS: We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467). RESULTS: Women in Queensland were more likely to have had a caesarean birth (36.2%) than women in England (25.1% of births; OR = 1.44, 95% CI = 1.28-1.61), after adjustment for obstetric characteristics. Between-country differences were found for rates of pre-labour caesarean (21.2% vs. 12.2%) but not for intrapartum caesarean or assisted vaginal birth. Compared to women in England, women in Queensland with a history of caesarean were more likely to have had a pre-labour caesarean and more likely to have had an intrapartum caesarean, due only to a previous caesarean. Among women with no previous caesarean, Queensland women were more likely than women in England to have had a caesarean due to suspected disproportion and failure to progress in labour. CONCLUSIONS: The higher rates of caesarean birth in Queensland are largely attributable to higher rates of caesarean for women with a previous caesarean, and for the main reason of having had a previous caesarean. Variation between countries may be accounted for by the absence of a single, comprehensive clinical guideline for caesarean section in Queensland.

Authors: Prosser, S; Miller, Y; Thompson, R; Redshaw, M

• Publication status: Published
• Journal: BMC pregnancy and childbirth
• Volume: 14
• Issue: 1
• Pages: 149
• Publication date: 2014-01-01
• DOI: 10.1186/1471-2393-14-149
• EISSN: 1471-2393
• ISSN: 1471-2393
• Language: English
• Keywords: Infant, Newborn; Cross-Sectional Studies; Questionnaires; Female; Cesarean Section; Adult; Pregnancy; Algorithms; Retrospective Studies; Queensland; Labor, Obstetric; England; Young Adult; Humans; Adolescent; Vaginal Birth after Cesarean