Births through caesarean sections dropped significantly last year, a cause for celebration for most midwives but not necessarily for the head of obstetrics at Mater Dei Hospital, who highlights the operation's value in risky births.

Although the number of such operations dropped by 245, this should not become the final goal, according to Obstetrics Department head Mark Brincat.

He still welcomed the decline but insisted that the drop "is not a goal in itself as the primary aim should be the safe outcome for the mother and the baby".

Paul Pace, president of Malta Union of Midwives and Nurses, believes births in Malta are heavily medicated and not allowed to follow their natural course.

Official figures show that the number of C-sections increased steadily between 1999 and 2006 but started dropping from 2006 when 35 per cent of deliveries were by C-section, further declining to 31 per cent, or 1,321 births, in 2008.

The drop was sustained as there were 1,076 births by caesarean delivery at Mater Dei, the Health Minister said in Parliament recently.

However, even though figures dropped over the past two years, they remain high compared to the average elsewhere.

Figures from the UK Department of Health show that the rate of C-sections in Britain in 2005-2006 stood at 23.5 per cent, more than 10 per cent below the figures here for the same period.

The figures go down drastically in Scandinavian countries. In 2006, 15.9 per cent of births in Norway, 16.3 per cent in Finland and 21 per cent in Denmark were by caesarean section.

Prof. Brincat insists these figures did not change much. "Valuable as these statistics might be, I am much more interested in treating each case on its own merit."

Moreover, he said, the high figures in the past could have just indicated a phase of high-risk pregnancies, such as older women or women with medical complications that levelled out last year.

Such high-risk pregnancies included breech births and twins, unusually small and big babies and all factors that had to be taken into consideration, Prof. Brincat said.

He denied that any gynaecologist would push patients to have a C-section instead of a natural delivery. "I don't think there are any obstetricians that pressure their patients to have a C-section without a truly valid reason."

Mr Pace disagreed and said there were many indications that mothers were encouraged to deliver by caesarean section. "C-sections are grossly and widely abused," he insisted.

Also, Malta was the only EU member state where the delivery team, including midwives, did not offer pre-natal care to the mother, Mr Pace said. Abroad, midwives followed the mother-to-be from the very start of her pregnancy until after birth. "Instead of always running to the doctors, such mothers will build a relationship with midwives," he said.