Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany.

A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states' professional midwives' organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.