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Open Access Highly Accessed Research article

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

Samantha J Prosser1, Yvette D Miller12*, Rachel Thompson13 and Maggie Redshaw14

Author Affiliations

1 School of Psychology, The University of Queensland, Brisbane, Australia

2 School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia

3 The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH, USA

4 Policy Research Unit for Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK

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BMC Pregnancy and Childbirth 2014, 14:149  doi:10.1186/1471-2393-14-149

Published: 26 April 2014

Abstract

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.

Keywords:
Caesarean section; Childbirth; Pregnancy; Cross-cultural comparison; Vaginal birth after caesarean; Previous caesarean section; Patient-reported data; Quality improvement