Impact of rising caesarean rate on stillbirths in Merseyside

Document Type



School of Nursing and Midwifery, East Africa


The authors of the Commentary from Ireland1 suggested aninverse relationship between caesarean rates and intrapartum stillbirth. We examined the trends in caesarean section and intrapartum stillbirths rate in nine maternity units in the Merseyside region, England for the period 1995 and 2001. The data had been submitted annually to the regional Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) Office as a part of an ongoing national audit. Prior to the commencement of the CESDI, it was agreed at national level to use the modified Wigglesworth Classifiction1toascertain a cause for each death using a standardised approach. There was significant increase correlation between the rate of caesarean section and the rate of intrapartum stillbirths (r ¼0.78, P ¼ 0.037) (Fig. 1). Similar trends were not seen for three other Wigglesworth’s groups, prematurity, congenital malformations and unexplained deaths where the correlations were 0.57, 0.12 and 0.62, respectively. The observed reduction in intrapartum stillbirths may be a consequence of a lower threshold for caesarean section both before and during labour. It may also be secondary to other improvements in antenatal and neonatal care such as increased use of antenatal steroids for lung maturity, surfactant for neonatal respiratory distress syndrome, better postgraduate education (mandatory training in CTG interpretation), the introduction of guide-lines and labour ward risk management. We did not expect to find such a strong correlation between caesarean section and intrapartum stillbirths and urge others toexamine larger data sets for similar trends.