The rise in caesarean section rates.

Much has been written about the rise in Caesarean section rates seen worldwide and in Ireland. The recent ESRI paper 1 suggested that physician behaviour might be an important factor in Ireland. The study concluded that changes in maternal characteristics accounted for only about half of the increase in Caesarean section rates but it did not include maternal obesity in the analysis (the data are not collected). This is an important omission because Ireland has one of the highest rates of obesity in the EU. Internationally, however, there is good evidence that much of the increase observed over the past two decades has been due to changes in maternal characteristics, notably delayed childbearing and obesity, and that the increase is essentially the result of biological phenomena.