The association between caesarean section rates in Ireland and private medical coverage

The rate of Caesarean sections has been increasing,1 despite WHO recommendations that rates should be between 10% and 15%. In developed countries in particular, there are now concerns that the surgery is at times performed unnecessarily, which can place the mother at potential risk both during the peri-partum period and for future pregnancies. Growing Up in Ireland is a national longitudinal cohort study of Irish infants and children. The first wave of the infant cohort is comprised of 11,134 nine-month-old infants. Questionnaires were carried out with caregivers. In the case of the biological mother a range of questions was asked regarding the pregnancy and birth. Data was statistically reweighted to represent the population structure of Ireland. Of the 11,094 responses from mothers, 58.2% [95% CI: 57.3-59.1%] reported a normal delivery. Caesarean sections accounted for 26.7% [25.9-27.6%] of births, of which 51.8% were emergencies and 48.2% elective. In a logistic regression model, which was adjusted for maternal age, parity, occupational household class and equivalised annual income, having a private medical insurance was associated with a 1.22 fold [1.09-1.37; p =0.001] higher chance of an elective caesarean delivery when compared with mothers without a private medical coverage. At 25.9%, Ireland has a higher rate of Caesarean section than England (23.0%) or than the European average of 19%, as reported by the WHO.2 Caesarean sections may be being carried out unnecessarily, particularly for mothers with private medical coverage.