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Skilled Obstetricians to avoid unnecessary Caesareans

A recent report has cautioned that junior doctors’ poor training is resulting in unnecessary emergency Caesarean births in many cases. Senior doctors have reported in this// week’s British Medical Journal (BMJ) that expert obstetricians can prevent several emergency Caesareans.

Currently, in the UK, the decision whether to try a vaginal birth, using forceps or a ventouse, or carry out a Caesarean is taken in the delayed second-stage labor by trainees. Experts revealed that there were "substantial differences" in the views of trainees and senior consultants.

The experts said: "A consultant obstetrician who performed a vaginal assessment was more likely to reverse a decision made by an obstetric trainee for a Caesarean and proceed to a safely conducted instrumental delivery." They said that although Caesareans were sometimes appropriate, "many could be prevented by the attendance of a more skilled obstetrician".

The facts from the Royal College of Obstetricians and Gynaecologists were mentioned in the study. Lack of labor progression is the reason given for 35% of Caesareans for single pregnancies of which 1/4th will develop labor after complete dilation of the cervix. However, no effort was taken to use forceps or a ventouse for a normal vaginal delivery in 55% of such cases. The rate of failure with instruments was 35% for ventouse and 2% for forceps.

The risk of major haemorrhage, bladder trauma and tearing are some of the risks associated with second-stage Caesareans. A recent Scottish study reveals that women who have had their first child by Caesarean section have less chances of conceiving again than those who gave birth naturally.

The experts said: "Without increases in junior doctors' experience and recruitment into the speciality, the problems with second-stage Caesareans will rise. Furthermore, women who undergo a Caesarean section are less likely to have a vaginal birth in subsequent pregna
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