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Obstetric complications among older women cannot explain their high caesarean rates

Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis

Delivery by caesarean section is associated with advancing age, yet a study in this week's BMJ finds that this relation cannot be entirely explained by obstetric complications among older women. This raises the question of why rates for caesarean section are high amongst older mothers.

The research team analysed over 23,000 deliveries to Aberdeen residents aged at least 20 years during 1988-97. Details of obstetric complications and interventions associated with a higher probability of caesarean section were used to investigate the association with age.

Among women who had not previously had a caesarean section and whose babies presented normally at delivery, there was a strong and consistent relation between maternal age and delivery by caesarean section that remained after controlling for relevant obstetric complications and other confounding factors. In contrast, the association between maternal age and both elective and emergency sections was either small or completely absent among women who had previously had a caesarean section or whose babies presented abnormally at delivery.

These results suggest that the relation between maternal age and caesarean section cannot be entirely explained by the obstetric complications considered in this study.

Physician and maternal preference may explain the higher section rates among older women, say the authors. However, further investigation is needed into women's views about increased intervention, the variation in rates for caesarean section among obstetricians, and how maternal age influences both of these factors, they conclude.

Contact:

Angela Begg, Public Relations Office, University of Aberdeen, King's College Aberdeen, Scotland. Email: a.begg@abdn.ac.uk

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