Hospital's £1.25m Caesarean bill

In 2005, 843 babies were born by Caesarean section at the hospital - a rate of 27 per cent, well above the national average of 21 per cent.

Since 2001 the number of mothers undergoing the procedure has soared from 19.5 per cent, a rise of hundreds of mothers going under the knife during birth.

National figures say each of these procedures costs £1,494 - which works out at £1.25million in York for 2005. A natural birth costs £758, about half as much.

The news comes after it emerged nationally that this kind of birthing procedure was on the rise - sparking claims the country's mothers were becoming "too posh to push" and costing the NHS nationally £80 million.

According to the World Health Organisation, the Caesarean birth rate in Western countries should be no higher than 15 per cent.

York Hospital's head of midwifery, Margaret Jackson said Caesarean births had been on the increase at the hospital for the past few years, but a new campaign was now driving rates down again.

She said: "The personal cost to the woman is a longer stay in hospital, a longer recovery with a surgical wound to cope with and a delay in getting back into a normal family life which includes looking after a new baby."

At York Hospital last year, the 39 mothers chose to have Caesarean sections, while 329 more were planned in advance for medical reasons. The rest of York Hospital's Caesarean births, 475, were delivered as emergencies. Over the year, 3,094 babies were born at the hospital.

Ms Jackson said the first group accounted for only "a small number" of mums, but said: "There is an issue around women having an operation which isn't necessary for them really.

"There are some that are done for medical reasons that may be surmountable if we have someone there with the mother.

"A lot of the work is to overcome medical factors or fears. It is the emergency Caesareans we are looking at reducing."

The hospital has launched a series of measures to encourage women to have their babies naturally, which has driven the number down from 27 per cent last year to 23 per cent - much closer to the national average - in the past four months.

Since September last year, a consultant has been on the labour ward from 9am to 5pm on weekdays - as well as on-call cover 24 hours a day.

Increased guidance was also being given to junior medical staff with a senior doctor involved in decisions.

A local audit of how many mums were choosing to have Caesareans had been carried out and an information leaflet had been developed.

Ms Jackson said having extra staff cost money, but it was hoped it would lead to cost savings in the long run.

It would also mean staff were available to talk to women before they went into labour.

She said: "I think it's about giving women the right support, before they even go into labour, so they can make a decision based on the facts. It's about being able to get back into family life, to be able to cope with the new baby."

Today Mike Proctor, director of nursing at the hospital, said the suggestion that mothers were "too posh to push" was unfair, saying: "I think that's an unfortunate term and it's not something I would like to use."

:: Infirmary's midwifery chief issues statement

MARGARET JACKSON, head of midwifery at York Hospital said:

"The national Caesarean section rate is 21 per cent and in York in 2005 it was 27 per cent of the births.

"In the last four months, since December 2005, the average caesarean section rate here has dropped to 23 per cent.

"The financial cost nationally of a birth by Caesarean section is £1,489 in comparison to a cost of £758 for a normal birth.

"The directorate of obstetric gynaecology and sexual health was already reviewing the local Caesarean section rate and looking at the reasons for this and exploring ways to reduce the numbers. Since September 2005, there has been a consultant presence on labour ward 9am to 5pm, Monday to Friday.

"This is as well as the on-call cover, 24 hours a day, 7 days a week.

"Meeting the recommendations of the Royal College Of Obstetricians And Gynaecologists has enabled the trust to provide increased guidance and support to the junior medical staff on labour ward with a senior doctor being present and involved in the decision making about the care to be provided. It has also increased the opportunities to provide training and guidance when clinical issues arise on labour ward.

"Staff will work with women and their partners during pregnancy before the labour starts so that the women are more aware of the options available to them.

"The trust is continuing to review the midwife and support staff numbers and review the roles they undertake. This is to support the work towards increasing the numbers of staff available and to release midwife time where appropriate to do so.

"The unit is unable to offer one-to-one midwife care to all women during labour, which, if available, has been proved to increase the likelihood of women giving birth normally with reduced pain relief, and without interventions.

"The Maternity Services Liaison Committee, which includes women who have given birth in York, is involved with and supports this review.

"The directorate is looking to work with the NHS Innovations And Improvement Team to share best practice from across the country and to learn from the experience of other units particularly those with a lower Caesarean section rate."

:: Dicing with death

WOMEN who give birth by Caesarean are overall five times more likely to die than women who give birth naturally - though the figures are tiny, 82 women out of every one million dying as a result of Caesarean, compared with 17 out of every million as a result of natural birth.

But they are more likely to suffer abdominal pain and bladder injury and they are more likely to need a hysterectomy.

Caesareans can be planned, when the medical need arises during pregnancy. They can also be an emergency, which arises during labour, or "elective", when a mum chooses to have one.

Sometimes a Caesarean is medically necessary, for example:

When a mum has pregnancy-related high blood pressure

The unborn baby is not receiving enough oxygen, but a quick natural delivery is not possible

Labour is not progressing, and the mother or baby are in distress

The mother has an infection such as HIV and a Caesarean would reduce the chances of the baby catching it.

A cut is made along a woman's bikini line which allows another to be made in the womb wall to deliver the baby. The operation is made under a general, spinal or epidural anaesthetic. The last two allow the mother to stay awake.

The word "Caesarean" is supposed to derive from the Roman Emperor Julius Caesar who is meant to have been born in this way. In fact the word Caesar itself derives from the Latin 'caedere', which means "to cut".

:: Section ops for both sons

BOTH of Paula Konefal's sons were born by Caesarean section. Her elder boy, Matthew, now four, was delivered in this way on medical advice because he had been lying in an odd way.

"It wasn't wholly an emergency but they told me I needed a Caesarean," said Paula, 34, of Hull Road, York.

Paula felt she would prefer to have her second baby, James, now six-and-a-half months, delivered by Caesarean because she had already undergone the procedure once before.

"I wasn't really bothered about it," she said.

"I thought I'd quite like to have a Caesarean because I'd had one before.

"With the first one it wasn't planned or anything. An hour later I'd had it, I didn't have much time to think about it!

"They are happy for you to have a second Caesarean if you want one. I thought it was the best thing for me, really because I'd had a previous one.

"That was my personal choice, they were happy for me to do it. Because the option was open to me, that was what I personally wanted."

:: Going under the knife was not my choice

YORK mother Tracy Robinson had given birth to four babies normally before her fifth child had to be delivered by Caesarean section.

Her waters broke when she was only 31 weeks pregnant, and doctors at York Hospital then discovered a green tinge in the waters, indicating there might be an infection.

The Evening Press reported recently how the surgeon's scalpel accidentally cut into her unborn baby, Tyler, causing permanent scarring on her bottom.

Tracy, now 31, of Bell Farm, says she too took longer to recover from the operation than from her four labours.

"I needed to have the Caesarean because of the infection, but if it hadn't been for that, I would have chosen a normal labour," she said.

"You can see what's going on, and cuddle the baby straight away afterwards, which helps you bond with it."

Updated: 09:46 Tuesday, April 04, 2006