Vol. 515 No. 2
11 Mr. Ferris asked the Minister for Health and Children his views on the significant variation in the rate of caesarean section operations performed in hospitals, particularly in view of concerns that these operations may lead to increased risk of illness and death among women; and if he will make a statement on the matter. [5495/00]
I am aware of the significant variations between hospitals in Ireland in the rate of procedures such as caesarean sections. While some element of such variation can usually be explained by reference to the complexity of cases being dealt with, it is important that the reasons for remaining variations be understood and explained. Accordingly, I have asked my Department's chief medical officer to seek the views of the Institute of Obstetricians and Gynaecologists as the organisation with professional responsibility for standards in this area. As with all medical interventions, caesarean sections should only be undertaken for sound clinical reasons in the interest of both mothers and babies.
Does the Minister accept that there is an extraordinary disparity where, in certain hospitals, a woman has a one in four chance of having a caesarean delivery and in other cases it is as little as one in eight? Generally speaking, there seems to be a correlation between the high level of caesarean sections and private hospitals. Has the Minister any views on the fact that generally we are above what the WHO regards as an acceptable level of 15%? While I am glad the Minister is consulting the Institute of Obstetricians and Gynaecologists would he not agree that there is considerable disagreement between obstetricians on this issue and there are some who articulate the view that if a woman wants a caesarean section she should be entitled to have one whereas others would argue strenuously that there are serious risks attached to having a caesarean delivery? It requires the Minister to put forward a policy on caesarean sections in maternity hospitals, after consultations, to ensure best practice is adhered to.
The Deputy has exceeded her time.
I share the Deputy's concerns. There is a wide variation between hospitals, as the survey by Cuidiú has established, from 12.5% in the National Maternity Hospital to 25% in St. Luke's General Hospital, Kilkenny. The World Health Organisation estimates that complications arise in at least 15% of all pregnancies. I am concerned but at the same time it is important to have full consultation with the body responsible in terms of professional standards and so on. I am obliged to consult with the professionals involved. I accept that there are differences in emphasis in terms of approaches by different obstetricians. The Department's chief medical officer has sought the views of the institute. Following receipt of those and further consideration, I will be interested in developing the right approach to this issue, in terms of the health of mothers and babies.
I share the concerns expressed by the Minister and Deputy McManus. I assume the Minister would agree that there should not be such a huge disparity in the number of caesareans in different maternity hospitals. There can be circumstances whereby a different number of operations may occasionally occur on an annual basis. Does the Minister agree that these variations are sufficiently substantial for genuine public concern? Does he agree that it was in the public interest that all hospitals asked to co-operate in the preparation of this report which resulted in this information did so? Does he regard it as acceptable that Tralee General Hospital failed to co-operate and was the only hospital providing maternity services which failed to provide information to the group which prepared the Cuidiú report? It should now be asked to make the missing information available.
The Department supports the work of the Irish Childbirth Trust. It is desirable that hospitals co-operate with the trust regarding surveys of this kind. Public information on hospital procedures is important. However, variations can occur because of different volumes of activity and the different nature of some hospital services. The prudent approach is to ensure there is full consultation with the professionals involved and that we work with them and those representing mothers and pregnant women to develop the best possible service.
