Articles do not paint an accurate or fair picture of maternity care

The 16 December article misquoted the C-section rate in England as 23%.This was only in the group when method of onset of labour was known. Often in population cohort studies, this information is missing. The overall percentage of C-section births in England was actually 42%, hence the UK headline ‘Two in five babies in England delivered by caesarean section’.

The subsequent article of 23 December ‘C-section was more common than a natural birth in 2023’ presented misleading information regarding local birth data. The article combined C-section and assisted vaginal births (using ventouse or forceps) and presented this as a local C-section rate of more than 50%. The data available was ‘208 babies were delivered via C-section, 197 delivered vaginally and 54 using instruments.’

The figure of 208 babies delivered via caesarean should be compared with 251 babies delivered vaginally (with instruments used in 54 births). This gives a local C-section rate of 45% which is comparable to the English rate of 42%. It should be noted that given our small population size, the local C-section rate does fluctuate year on year. Most recent data from 2024 show caesarean births accounted for 37% of births in Guernsey.

We recognise there will sometimes be a lower threshold to offer an emergency C-section in labour to maintain patient safety due to the lack of an alongside maternity theatre until Phase 2 of the hospital modernisation project is complete. Despite this necessary variation to local practice, C-section remains less common than a vaginal birth.

The article quotes ‘high induction rates in Guernsey can lead to more C-sections’. Our induction rate is also comparable to the NHS. The reason for recommending induction, eg concerns regarding baby’s growth, means a C-section is more likely. There is no suggestion that the induction itself raises the likelihood of caesarean birth.

We would like to strongly contest the follow up statement ‘at the hospital you do things on their terms’. It is a shame that a member of our maternity team was not given an opportunity to comment. As a group of consultants, our approach is to work closely with the midwives to put the needs, preferences, and values of every birthing person and their family at the heart of the care we provide. This means supporting informed choice, which includes the choice to birth by C-section after information regarding risk and benefit of surgical birth has been discussed. This is in line with national guidance from the National Institute for Clinical Excellence (NICE).

Unfortunately, the original article did not highlight why national maternity safety policy in the UK has moved away from chasing a low C-section rate. It has been a recurrent theme of maternity safety enquiries in the UK that aiming to achieve and maintain a low C-section rate is associated with worse outcomes for both women and their babies.

We hope that presenting an accurate picture of local birth data, namely that our local caesarean rate mirrors that seen in England, will be reassuring to women and their families in Guernsey, who may have been alarmed to originally read that they were more than twice as likely to have a caesarean here than in England.

MISS LAUREN GREEN

Consultant obstetrician and gynaecologist and obstetric lead, on behalf of the obstetric team at the Medical Specialist Group

Editor’s footnote: The article quoted from 16 December only appeared on our website and is a story supplied by the Press Association. The Guernsey Press had no editorial involvement. The error highlighted in the article of 23 December was due to our misinterpretation of statistics provided in a freedom of information request. We apologise for the error.