Shift in social class of mothers undergoing Caesarean sections in Scotland
A new Medical Research Council study has shown that advantaged mothers in Scotland are more likely to have their babies by planned Caesarean section than mothers living in poorer circumstances. Emergency Caesarean sections, however, are equally distributed across the social spectrum. The findings mark a sea change in practice compared with thirty years ago, when those from poorer backgrounds were more likely to have Caesarean sections, both planned and emergency.
In the study, researchers from the MRC/Chief Scientist Office Social and Public Health Sciences Unit in Glasgow used patient records of over 350,000 mothers in Scotland and examined who gave birth by Caesarean section in different time periods spanning twenty years. They then investigated the social class of the mothers who underwent the procedure and the level of deprivation of the area they lived in.
Medical Research Council researcher Ruth Dundas, who led the research, described how the trends in Scotland changed over time:
“Thirty years ago mothers having Caesarean sections were more likely to come from deprived areas and/or from a lower social background. This was true for both elective and emergency sections. Ten years later the rates had changed so that, although women from a lower social background were more likely to have emergency sections, there was no difference between them and women from a higher social background in elective surgery rates. By 2000 the rates had equalized for emergency section, but mothers from the higher of the social classes measured were the more likely to give birth by elective surgery.”
Giving birth by Caesarean section can be a lifesaver for both mother and baby, but there are risks involved in such a major abdominal surgery and increased costs due to extended hospital stays.
Ruth Dundas continued:
“The disappearance of social trends for emergency Caesarean section reflects increased equality in health care. However this does not explain the differences seen for elective section rates. It is important to ensure that the clinical decision making process is the same for all women, regardless of their background.”
Professor Sally Macintyre, Director of the MRC/CSO Social and Public Health Sciences Unit, said:
“The relationships between health care received and socioeconomic status are complex. One of the Medical Research Council’s challenges is to explore and address these, so that everyone has an equal chance of the best healthcare.”
The research is published in BioMed Central’s open access journal BMC Public Health today.
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