Correspondence

Health sector reform and rise of caesarean birth in Chile

The effects of complete methods of cesarean section (CS) were compared. Metaanalysis of randomized controlled trials of intention to perform CS using different techniques was carried out. Joel-Cohen–based CS compared with Pfannenstiel CS was associated with reduced blood loss, operating time, time to oral intake, fever, duration of postoperative pain, analgesic injections, and time from skin incision to birth of the baby. Misgav-Ladach compared with the traditional method was associated with reduced blood loss, operating time, time to mobilization, and length of postoperative stay for the mother. Joel-Cohen–based methods have advantages compared with Pfannenstiel and traditional (lower midline) CS techniques. However, these trials do not provide information on serious and long-term outcomes.

Objective: To assess UK obstetricians’ preferences about mode of delivery for themselves or their partners and determine whether these changed since 1995. Study Design: All 313 registered obstetricians in London and one in five (279) sample of those outside London were sent a structured anonymous postal questionnaire. Results: The response rate was 54%. In a hypothetical uncomplicated first singleton pregnancy with a cephalic presentation at term, 15% chose elective caesarean section (CS) (17% in London versus 13% outside London). The overall rate for London has not changed since 1995 (17 versus 17%), although the difference between women and men was less (31 versus 8% in 1995 and 21 versus 14% in 1999, respectively). The number choosing elective CS increased with estimated foetal weight >4.0 kg (40%) and >4.5 kg (65%) and with breech presentation both in a first pregnancy (69%) and after a previous vaginal delivery (49%). Conclusion: The overall attitude of London obstetricians to mode of delivery for themselves or their partners has not changed since 1995 and is similar to those of UK obstetricians elsewhere.