Planned Caesarean births have doubled in 20 years in Scotland

Last year in Scotland, 39% of all births were caesareans

The number of planned Caesarean births in Scotland has more than doubled in the past 20 years, according to new figures obtained by BBC Scotland.

Public Health Scotland said there were 8,884 elective C-sections last year - where the surgery has been planned in advance - up from 4,285 in 2001.

The number of emergency Caesareans also rose, from 7,526 to 9,359, despite the total number of births falling.

Experts have attributed the rise to higher obesity rates and older mothers.

Consultant obstetrician Dr Rosie Townsend, a senior clinical research fellow at the University of Edinburgh, said an increasing number of women were having their first child by Caesarean.

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That leads to them being more likely to have later children by the same method.

The largest group of women planning the procedure had either had a Caesarean or experienced a difficult delivery with their first pregnancy.

Dr Townsend said the number of C-sections was also rising due to women having babies older, slightly heavier and with more health complications.

The World Health Organization advises that a maximum of 15% of births should be by caesarean section, but most countries exceed this limit.

In 2019/20, they accounted for 31% of births in England, 28% in Wales and 34.5% in Scotland.

Dr Townsend said: "We know that Caesarean section rates are really rising in a lot of areas of the world and what we're seeing in Scotland is really consistent with rises in England, Wales and Northern Ireland.

"This is a concern to obstetricians and to maternity workers around the world.

"Are we doing too many? Are we doing the right Caesarean sections? I think it's right we think about that and look into it a little bit more."

Dr Townsend said there is a year-on-year increase of women who elect for a Caesarean without a having medical reason but they are a small group, who do not take the decision lightly.

The National Institute for Health and Care Excellence (Nice) published guidelines in 2011, and updated in 2021, on a woman's right to choose how she gives birth.

It states that if a mother still does not want a vaginal birth after discussing the benefits and risks, the medic should "offer a planned Caesarean birth for women requesting a Caesarean birth."

Kelly Borthwick gave birth to her son Struan by elective c-section last year

Kelly Borthwick, 40, who lives in Elgin, gave birth to her daughter, Skye, and son, Struan, through elective C-sections. They are now aged four and one.

A planned caesarean was recommended for her first child after ultrasounds showed Skye was in a breech position but Kelly said she had initially been "really upset" at the prospect.

"I was pretty gutted and it took me a couple of weeks to accept the fact that I was going to be having a section," she said.

"When it came to Struan obviously I knew what to expect and never having a natural birth, the tables turned a little bit - I was a little bit fearful of having a natural birth."

Kelly said her consultant had recommended a Caesarean, telling her that she was "pretty much too old to push".

She had also wanted to avoid the uncertainty of a long journey to Aberdeen, which takes at least 80 minutes, while in labour.

Danielle Jackson planned to have her second son by Caesarean after she had an emergency C-section with her first born

Danielle Jackson, 35, who lives in Dyce on the outskirts of Aberdeen, has two sons who were both born via C-section. Malik is 19 months and Zaire is one month old.

Her first pregnancy ended in an emergency operation after she had been in labour for 30 hours.

"This time around I thought I really want to take matters into my own hands, I don't want to feel pressured or cornered or let situations get away from me," she said.

"I really felt as though an elective C-section would give me, for want of a better word, as much control of the situation as I could have, even though my recovery last time was really tough."

Despite having scheduled a date, her baby had other ideas and Ms Jackson went into labour two weeks early.

She was placed on the emergency list, but said it was still a very calm experience.

"There was Lewis Capaldi playing in the background," she said. "It was just super positive, which is exactly what I was going for."

Medical reasons

Consultant obstetrician Dr Alastair Campbell said there had been an increase in Caesarean births over the past decade throughout the UK due to a higher number of complex births.

"Two contributing factors to this trend are the rising rates of obesity and an increase in maternal age of those giving birth," he said.

"These factors can lead to an increased chance of Caesarean birth as this may be safer for mother and baby."

Dr Campbell, who is a spokesperson for the Royal College of Obstetricians and Gynaecologists, said the majority of planned Caesarean births were for medical reasons.

Figures provided to BBC Scotland by Public Health Scotland showed that the health boards with the highest percentage of planned C-sections in 2021 were NHS Grampian and NHS Greater Glasgow and Clyde, both with 22%.

A report published by the Scottish government last year said the country had the highest overall rate of Caesarean sections in Great Britain.

A spokesman for the Scottish government said rates of C-section had steadily increased throughout the world over the past three decades.

He said: "Maternal age has continued to steadily rise and older women are more likely to have a Caesarean section: 59% of women were 30 years or older at the time of giving birth, which is the highest proportion since reporting began."

The spokesman said a range of other factors may be contributing to the rise and data suggests there is considerable variation across Scotland. He said work was being carried out to improve understanding.

"Caesarean section is a safe mode of delivery for both mother and baby and there are a number of good clinical reasons why this may be recommended," he added.

"Decisions about mode of delivery should be made in partnership with women, taking account of their individual circumstances, preferences and clinical needs."

University of Edinburgh researchers have recently begun a new birth cohort study - Born in Scotland - which is now open to pregnant people in the Edinburgh area.

Researchers hope the study will highlight the factors associated with healthy pregnancy and different types of birth in modern Scotland.