Almost four in 10 births at St Luke's Hospital in Killenny are via caesarean section, new figures from the HSE have revealed.

The figures relate to the country's 19 public maternity units and include information on the rates of caesarean sections, instrumental deliveries and episiotomies being carried out.

They reveal that St Luke's in Kilkenny has by far the highest caesarean rate in the country - at 38%. Other maternity hospitals with high caesarean rates include Cavan General (30%), Our Lady of Lourdes in Drogheda (30%), Tralee General (29%), University College Hospital Galway (29%) and Dublin's Rotunda (29%).

The lowest caesarean rate was found to be Sligo General Hospital (19%), followed by the National Maternity Hospital in Holles Street (21%) and Waterford Regional (22%).

Commenting on the figures, the Association of Improvements in Maternity Services (AIMS), described the St Luke's figure as ‘very worrying'.

"We very much welcome the publication of this information on a per unit basis. Until now, women availing of maternity services in Ireland have been in the dark about the level of interventions performed at their local maternity units and this data will help inform them about where best to have their babies.

"The statistics show that there are marked regional variations in obstetrical intervention for hospital births," commented AIMS co-chairperson, Krysia Lynch.

She noted that the World Health Organisation (WHO) recommends a national caesarean section rate of 10-15%.

Meanwhile, the figures also revealed varying rates of episiotomy depending on which part of the country a woman gave birth in.

An episiotomy is a surgical cut that is made to a woman's perineum - the area between the opening of the vagina and the anus (back passage). It used to be relatively common in childbirth as doctors believed it could benefit the woman by, for example, reducing the risk of more extensive vaginal tears during childbirth.

However, research has shown that this is not the case and the procedure should only be carried out in certain circumstances, for example, if the baby is distressed and needs to be born quickly, but the vagina is not stretching enough to allow this.

However, the HSE figures show that at least 27% of births in the National Maternity Hospital at Holles Street involve an episiotomy, far above the hospitals with the next highest rates - University College Hospital Galway, Cork University Maternity Hospital and the Midland Regional Hospital in Mullingar (all 19%).

According to Ms Lynch, the Holles Street figure ‘is a cause for concern'.

The lowest episiotomy rate was found in Wexford General (10%), followed by Portiuncula Hospital in Ballinasloe and Cavan General (both 13%).

The figures also looked at the rate of instrumental births, i.e. the use of forceps or vaccum (ventouse). They revealed that the highest rate of instrumental deliveries took place in Waterford Regional (21%), followed by Dublin's Rotunda (19%) and Mayo General (18%). The lowest rate was found in Letterkenny General (10%), followed by Wexford General (11%) and the National Maternity Hospital at Holles Street (12%).

Ms Lynch noted that while AIMS is ‘delighted' that these figures are now available to women, ‘we are concerned that these regional variations in obstetric interventions across Ireland essentially present women with a geographic lottery in terms of their maternity care'.

She insisted that there is no standardised maternity care in Ireland and she called for an overhaul of the country's current maternity care model.

"Our maternity services are 90% obstetric-led and lack continuity of care. Outdated practices, which are evident in this data, are of no benefit to the majority of women. High quality robust evidence, including the recently published Cochrane Review on midwife-led care, shows that the large majority of women benefit from a midwifery-led care model, not obstetric," she explained.

She added that while obstetric-led care has ‘a very important place in Irish maternity services' and should be available for women who want or need it, ‘in failing to provide evidence-based care options, valuable resources are being over-utilised as women have no option but to birth in understaffed and overcrowded consultant-led units'.

The figures were released by the HSE under the Freedom of Information Act.

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