Many emergency caesareans could be prevented if skilled rather than junior doctors made decisions on how a baby should be delivered, experts have warned.
A study published today in the British Medical Journal reveals "substantial differences" in the opinions of consultants compared with more junior colleagues on how a woman with a delayed second-stage labour should deliver her baby.
The study carried out by expert consultant obstetricians from Essex, Dublin and London found as many as two thirds of caesareans could be prevented by the attendance of a skilled obstetrician.
At present trainees make most of the decisions, despite their inexperience.
Virginia Beckett, a consultant obstetrician and gynaecologist at Bradford Teaching Hospitals NHS Foundation Trust and spokesman for the Royal College of Obstetricians and Gynaecology, said the issue was complex, with a combination of factors preventing consultants being available on maternity wards for 24 hours rather than just on call.
"We do have a problem with recruitment in obstetrics and gynaecology and we are working hard on that at the moment," she said.
"Medical students and newly qualified doctors don't find it as attractive as other specialisms because it's intrusive on one's personal life (such as unsociable hours)."
She said the Royal College of Obstetricians and Gynaecology had made recommendations for consultants to be available on maternity wards 24 hours a day, rather than the present arrangement of them being on call.
In Bradford, she said, consultants provided 40 hours of cover a week, which was increasing to 60 hours.
"We want to provide cover 24 hours a day but in order to do that we would have to double the number of consultants," she said.
"That's got huge financial implications for the trust and there are not the consultants there to recruit."
She said junior doctors' hours had been reduced over the last ten years and, while that was to be welcomed, their exposure to difficult births had fallen.
"As a consequence of the reduction in hours, junior doctors are less exposed to the things they need to see in order to become experienced," she said.
She also said Government plans to cut the length of postgraduate training did not help the situation and lots of women did not want a difficult delivery that may involve a great deal of tearing.
However, Ms Beckett did say that junior doctors were receiving specific training on difficult birth and although they were seeing fewer cases they were probable being better trained.
Dangers from caesareans include the risk of major haemorrhage, bladder trauma and tearing. Woman are also more likely to have to stay in hospital for longer following the birth.
The study found that as many as two-thirds could be prevented and were due to operator inexperience.
e-mail: claire.lomax@bradford.newsquest.co.uk
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