Hospitals in Scotland have been urged to investigate the number of caesarean sections being carried out.

According to research, nearly a quarter of all pregnant women now go under the scalpel to give birth in some of the country's maternity units.

Caesarean sections used to be carried out only in emergencies when the health of the child or the mother was endangered.

Many doctors have in the past blamed the rise in the number of sections on maternal request - allowing busy women to have the operation at a time convenient to them.

However, figures now show that only a small proportion of caesareans have been carried out at the request of the mother and one of the main reasons for the rise was that doctors were concerned about being sued.

"Defensive practice"

Margaret McGuire, of the Royal College of Midwives, said that with the protocol and guidelines currently in place, it should not be necessary "purely on the basis of defensive practice".

She added: "We do not have any evidence that women are actually choosing to have caesarean sections.

"The most recent audit showed only 0.4% of women opted for that method."

A working group commissioned by the Scottish Executive to study caesarean rates highlighted a huge variation between hospitals, but could not account for the reasons why.

At Paisley's Royal Alexandra Hospital, the caesarean rate was found to be as high as one in four births, while at Falkirk's Royal Infirmary, which covers a similar demographic area, the rate was only 13%.

Consultant obstetrician gynaecologist Dr Burnett Lunan, who sat on the working group, said they had tried to eliminate factors which might have had a bearing on the study, like social background and height.

He said that after those factors had been discounted, there were still differences between hospitals.

"Invasive and serious"

Dr Lunan added: "We came to the conclusion that staff attitudes were different, and expectations were different, and that they were guiding patients to an outcome of their pregnancy that was at variance with what we would regard as normal."

Liz Goudie, of the National Childbirth Trust, said that in areas where the rate was highest, patients were less likely to object to undergo caesarean.

She said: "If you live in an area with the highest rate, you're less likely to question that this very invasive and serious operation is going to be performed if you know several people for whom that's been the case.

Internal review

"Maybe it undermines your confidence in your ability to give birth naturally."

The Royal Alexandra Hospital has said it will now be reviewing its rates on a month by month basis.

The executive wants other hospitals to carry out internal investigations into why some were carrying out high numbers of caesarean sections.