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One in four births in England is now emergency caesarean, BBC analysis shows

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A quarter of all babies in England are now delivered by emergency caesarean operations, BBC analysis shows – marking a significant rise over the last five years.

The unplanned surgeries have increased by eight percentage points, while the rate of elective caesareans has also increased.

At the same time, the rate of vaginal births without instruments has fallen – from more than half of all deliveries to 43%.

Prof Marian Knight, director of the National Perinatal Epidemiology Unit, which researches the care of women and babies in pregnancy and birth, says the rise represents a "total change in how women give birth" in England, and that it has not been replicated in other European countries.

The NHS does not publish data on why an emergency C-section is performed, and experts say there is no single, clear explanation for the increase.

However, some have told the BBC they are concerned a culture of fear in maternity units and among pregnant women is driving up the number of procedures.

The Royal College of Obstetricians and Gynaecologists, which represents maternity doctors, says pressure on staff and operating theatres means the system is "really struggling" to meet the increased demand.

NHS England says "decisions are made by considering individual circumstances and clinical advice to ensure the safest and most appropriate approach for each birth".

A caesarean section, or C-section, is a cut through the mother's tummy and womb.

Emergency C-sections are graded from the most urgent – where there is an immediate threat to the life of the woman or the baby – to those where labour is not progressing well.

BBC Verify has tracked the changes in births in England over five years.

The most common way to have a baby is still a vaginal delivery where medics don't use instruments such as forceps to help pull the baby out – but that has fallen from 53% to 43% of births.

Planned caesareans now make up 20% of births and there has been a steady increase in emergency caesareans – from 18% to 26%.

Figures from other parts of the UK are not as up to date, but put emergency caesarean rates at 22% in Scotland, 20% in Wales and 16% in Northern Ireland.

Prof Knight's unit has compared how caesarean birth rates – both planned and emergency – have changed across 42 countries.

Her team ranked each country on the proportion of C-section births, from highest to lowest. In 2020, England was 14th out of 42 countries – but by 2025, it was up to 9th.

She says the other countries are generally not seeing such sharp increases.

Despite the rise in emergency C-sections since 2020, stillbirths and neonatal mortality have remained largely unchanged.

Shakila Thangaratinam, professor of women's health at the University of Liverpool and a consultant obstetrician, says: "An increase in emergency caesarean sections poses concern if these are not accompanied by a corresponding decrease in stillbirths, newborn and maternal complications."

She says reasons for the rise are largely unknown, adding there is "no clear and consistent reporting". And she says it will not be possible to explain increases without "good quality data" about why operations are performed.

Prof Thangaratinam says she also wants to explore what part race has to play. While the national average for emergency C-sections is one in four births, it is about one in three for black and Asian mothers.

Prof Knight is investigating whether factors like age, obesity and pre-existing medical conditions are contributing to the increase – but she says NHS staff and mothers may also be influenced by high-profile maternity scandals.

For years, maternity units were told to keep rates of caesareans low. Those targets were dropped in 2022.

Recent maternity safety scandals in Morecambe Bay, East Kent and Shrewsbury and Telford all heard similar, devastating stories of mothers and babies dying and a reluctance to do caesareans. Ongoing inquiries in Nottingham and Leeds are likely to have similar concerns.

"We also need to recognise the potential impact of rising fear among women, families and staff, which may lead more to choose or to recommend caesarean birth," she says.

Another health professional told the BBC no one wants to be the next scandal.

Over the last five years, there has also been an 11% increase in the number of legal claims against the NHS for maternity problems.

"Legal cases typically question why caesareans are not undertaken or not undertaken sooner," Prof Knight says. "Doctors and midwives are rarely criticised for performing an early caesarean."

NHS England says "many factors" influence caesarean births and its "priority is always the safety and wellbeing of both mothers and babies".

The BBC spent two days in the maternity unit at Northwick Park Hospital in London and met 18-year-old new mum Khushi.

She had an emergency caesarean because her baby's heart rate kept slowing down during labour. It was classed as category one, the most urgent type.

Khushi says she was baffled and scared – that she had no clue what she was getting herself into.

"It was my first ever surgery. Just the thought of being open on a table still feels so surreal and so unbelievable," she adds.

Now at home with baby Aarav, she faces six weeks physical recovery from the major surgery, but says the mental trauma is the hardest part for her.

Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, has been delivering babies for 35 years. She worries how services will adapt to the increased number of emergency C-sections.

She says many maternity units already don't have enough dedicated obstetric theatres.

"If we do not invest in our workforce and in our operating theatre capacity, we may be in a position in the future where we cannot do the emergency caesareans we need to," she adds.

Prof Ed Wilson, health economist at the University of Exeter, says that according to NHS data, a routine vaginal delivery is almost £4,800. A planned caesarean would be about £6,000.

But he estimates that emergency C-sections cost almost £9,000.

An NHS spokesperson says: "The increase in the number of emergency caesarean births is influenced by many factors, and our priority is always the safety and wellbeing of both mothers and babies.

"Decisions are made by considering individual circumstances and clinical advice to ensure the safest and most appropriate approach for each birth."

The Department of Health and Social Care says it was committed to improving maternity and neonatal safety and pointed to Health Secretary James Murray's role as chair of the national maternity taskforce.

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Here's to you, Ollie Robinson – England need you more than you will know

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How's that for a return?! Robinson takes three wickets in first over in two years

Paul Farbrace has a gag about how Ollie Robinson came to be Sussex captain.

Farbrace, the Sussex head coach, realised he had not got his step-son a decent Christmas present, so offered him the county captaincy instead.

It's a nice line. The truth is that Sussex wanted to get the absolute best out of their champion bowler and reasoned it would come through more responsibility.

Around the same time, England were getting their quadrennial shellacking in Australia. Among the myriad of English plans to fail down under was the idea of hitting the Aussies with high pace and hostility.

And so Robinson and England were once again set on convergent paths, culminating in his comeback for the ages on day one of the first Test against New Zealand.

With three wickets in his first over in an England shirt for more than two years, Robinson added his own moment of history to a Lord's ground celebrating its 150th Test. He reannounced himself as an international bowler, gave life to England's post-Ashes rebuild and quite possibly provided precious breathing space to the management that once discarded him.

It is 829 days since Robinson last played for England and 1,069 since he was last able to celebrate a wicket.

To look at Robinson's statistics would shed no light on the reason for his absence. A return of 76 wickets from 20 Tests at an average below 23 with a strike-rate better than 50 is world-class.

But England decided that Robinson was not worth the hassle.

On his Test debut in 2021, he was discovered to have made racist and sexist social media posts as a teenager. On the Ashes tour of that winter, his fitness was publicly questioned by then England bowling coach Jon Lewis.

Robinson was on the outside when the Bazball revolution began in 2022, yet, by the end of that summer, Robinson, calling himself a "gym freak", was a fixture under Brendon McCullum and Ben Stokes.

The harmony lasted little more than a year. Robinson suffered a back problem in the Headingley Ashes Test of 2023. When he returned in the fourth Test against India in Ranchi the following year, Robinson was struck by more back issues and dropped a crucial catch.

Off the field, he had gone through the break-up of a relationship and England were not impressed by a podcast he made with new partner, the golf influencer Mia Baker. McCullum and co had had enough.

Robinson ready to put in hard work after dream return

Stunning Robinson return gives life to England

Robinson was exiled for 24 Tests. In that time, 13 other men bowled seam in Test cricket for England. Fourteen, if you count Harry Brook's wrong-footed part-time filth.

Robinson spent part of the Ashes winter playing club cricket in Sydney, mainly to work on his game, but also to be in the right place if England needed him. One wonders how many bowlers would have had to go down for Robinson to get the call, especially given a reserve Lions squad was also in Australia. Maybe 15, even 20?

But necessity is the mother of invention or, in this case, reinvention.

Humbled in Australia, England were badly in need of an attack-leader, a reliable tone-setter.

This summer is the first since 2007 that none of James Anderson, Stuart Broad or Chris Woakes will play a Test for England. Throw in the likelihood that Mark Wood will never play another Test and it means the four cornerstones of England's pace attack have gone in the space of three years, taking 1,609 wickets with them.

So England reached out to Robinson, telling him at the start of the summer he was back on the radar. Already maturing with the captaincy, Robinson lasered-in on the goal of an international recall.

Those at Hove speak of an intense focus on a chance Robinson once thought had gone. Extra training sessions, leading on and off the field amid the turmoil of a points deduction for financial issues. The bowling was in good order, and there was even a vital century with the bat against Surrey.

When the England recall came, director of cricket Rob Key called Robinson "one of the best bowlers in the world". McCullum said he had "banged the door down", while Stokes challenged Robinson to "stay here as long as he can".

On a murky and moody Thursday at Lord's, Robinson rose to the challenge.

England had been rolled over for 140 by the excellent New Zealanders and all of Key, McCullum and Stokes must have been wondering if the Ashes rebuild was going to be reduced to rubble. Salvation came from the man they had shunned.

With the clouds hovering, rain threatening and pitch nibbling, Robinson was the perfect horse for this course.

Rumbling in from the Nursery End, nipping the ball down the slope to left-hander Devon Conway.

Third ball. Front pad. Finger up. Robinson's eyes wide with delight, Conway aghast at a review that showed enough of leg stump was being clipped.

Highlights: 16 wickets fall on opening day as England fight back against New Zealand

Two balls later and the crowd were singing Robinson's name as he rocked his shoulders towards Kiwi great Kane Williamson. Perfect length, Kane not able to get a proper stride. An inside edge to short leg.

Yet more to come. Rachin Ravindra. Another left-hander and another ball jagging down the Lord's slope. Only pad between ball and stump. A triple-wicket maiden and a return to go down in English cricketing folklore.

There was still time for one more trick of the hand. Daryl Mitchell not playing a shot, but this time the ball darted up the slope to uproot the unguarded off stump. Robinson sleeps with figures of 4-10, New Zealand on life support at 61-6.

The irony in all of this is the party line from Key, McCullum and Stokes on Robinson's prolonged absence.

Their demand has always been for Robinson to hit "82, 83 or 84 mph". On the first day at Lord's, Robinson's average speed was 80.3mph, the slowest of the eight seamers on show – including injured New Zealander Matt Henry. His fastest speed was 82.3mph – which he hit once – and slowest was 77.1.

Where Robinson excelled was in expert use of the helpful conditions with immaculate line and length, topped off with fingertip control to have the ball skipping off the seam.

Robinson ended the day on 80 Test wickets at an average of 21.9. Not since the legendary Fred Trueman hung up his boots in 1965 has any England bowler taken that many Test wickets at a better average. Using the same 80-wicket qualification, Robinson's strike-rate of 47.9 is the best since Sydney Barnes, whose career ended 112 years ago.

Is Robbo's return bittersweet? The wonder of what might have been, especially on those juicy pitches in Australia?

Perhaps it could only have been now that Robinson was ready for this moment – he admitted he was "nowhere near" being able to play a role in the Ashes.

So, Robinson is back. On this showing, for how long is up to him.

Here's to you, Ollie Robinson. England need you more than you will know.

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Andrew was sub-letting Royal Lodge cottages, watchdog reveals

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Andrew Mountbatten-Windsor received an undisclosed rental income from sub-letting three cottages on the Royal Lodge estate that he leased from the Crown Estate, the public spending watchdog has revealed.

The National Audit Office (NAO) report also revealed that the King pays the rent for accommodation in royal palaces for Mountbatten-Windsor's daughters Princesses Eugenie and Beatrice, who are not working royals.

It is the first report into royal residences in 20 years and shows Mountbatten-Windsor and his family and staff had 12 properties, owned by the Crown Estate or the Royal Household.

A Buckingham Palace spokesman said the report was "in line with the Royal Household's commitment to transparency".

The watchdog report into royal residences shows that Princess Eugenie has a property in Kensington Palace and Princess Beatrice in St James's Palace.

They do not pay any rent for this central London accommodation, instead it is paid by the "privy purse", which is the monarch's personal money, to the Royal Household.

Both of the palaces are maintained by public funding, through the Sovereign Grant.

Norman Baker, former Home Office minister and critic of royal finances, said it was "outrageous to subsidise luxury accommodation" in this way and that the public was "being taken for a ride".

He said such arrangements should no longer be sustainable and that "deference is wearing thin indeed".

A Palace source said that the rent paid on these properties for non-working royals would cover any publicly-funded expenditure, so there would be no extra cost to the Sovereign Grant, which pays for the official duties of the monarchy.

The report does not specify how much rent is paid on the princesses' palace property, but the level is meant to be 60% of the open market rate.

The NAO report was prompted by the scandal surrounding Andrew Mountbatten-Windsor – and will be followed by an inquiry by MPs on the Public Accounts Committee.

It shows a collection of 12 properties used by Mountbatten-Windsor and his family.

Even though Mountbatten-Windsor left Royal Lodge earlier this year, moving to Sandringham in Norfolk, he still has the lease on Royal Lodge until October 2026.

There is no suggestion in the NAO report of any wrongdoing by Mountbatten-Windsor.

As well as the main building at Royal Lodge, there were another eight nearby properties, with Mountbatten-Windsor's lease allowing three of these cottages to be sub-let, which he did until April 2026.

The report does not say how much he received in rental income, but Palace sources suggest he rented the property to staff or retired staff and the amount was only enough to cover running costs.

Whatever the amount, it went to Mountbatten-Windsor rather than the Crown Estate, which would pay its profits back to the Treasury.

Mountbatten-Windsor had paid £7.5m for repairs when he took on the lease for Royal Lodge, and that meant that he did not have to pay a monthly rent.

He also had another lease for a property called East Lodge, which the BBC previously revealed was to be handed back to the Crown Estate.

His two daughters have homes in the Cotswolds and in Portugal as well as their royal properties in the palaces.

The report also reveals that the Crown Estate paid for repairs worth almost £400,000 before the Prince and Princess of Wales moved into their Windsor home at Forest Lodge.

Princess Michael of Kent, another non-working royal, also has a property in Kensington Palace which is paid for by the privy purse.

Eleven working royals have accommodation in the palaces without charge in exchange for their official duties.

These are: the King and Queen, the Princess Royal, Duke and Duchess of Edinburgh, Duke and Duchess of Gloucester, the Duke of Kent and Princess Alexandra. And the Prince and Princess of Wales have an apartment in Kensington Palace, as well as their Crown Estate property.

The report found 21 other royal post-holders, including 17 military knights, have accommodation without charge in the occupied palaces.

The NAO report doesn't make any judgements on value for money or draw any conclusions, but it is intended to provide information for MPs on the Public Accounts Committee.

"Our role is to set out the facts – and that's why this is an investigation that sets out the processes and the arrangements both from the Crown Estate and the Royal Household," said NAO director Lee Summerfield.

A Palace spokesman said it was "grateful" for the report which was "in line with the Royal Household's commitment to transparency".

"We hope that the findings will help correct, clarify or contextualise a number of points regarding royal properties," the spokesman added.

"As the report notes, arrangements for properties managed by the Royal Household vary based on a number of factors to ensure residences are filled appropriately, depending on their location, tenants and purpose," he said.

A spokesperson for The Crown Estate, said: "The Crown Estate welcomes the National Audit Office's review which confirms its leases with members of the royal family were agreed in line with independent, professional advice and open market valuations."

Sign up here to get the latest royal stories and analysis every week with our Royal Watch newsletter. Those outside the UK can sign up here.

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Mangrove forests are healing after decades of human destruction

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The world's coastal mangrove forests, which protect millions of people from storms – and soak up vast amounts of planet-warming gases – are staging an unexpected comeback, scientists find.

For decades these swampy trees had been declining rapidly as they were cleared for fish farms and housing.

But a new study shows that since 2010 the world has been gaining more mangroves than it has been losing – driven by stronger legal protections and increased public awareness of their importance, sparked by disasters such as the 2004 Indian Ocean tsunami.

The researchers say the key factor though is the remarkable capacity of these forests to regenerate naturally once humans stop chopping them down.

Mangroves are one of the world's unsung environmental heroes.

Not only do they store up to five times more carbon dioxide than land-based forests, but their tangled roots can also slow down waves and protect coastal communities from storm surges and tsunamis.

These same roots provide a perfect nursery for many species of fish and other marine life – protecting them from predators and providing ample food.

These benefits, though, have come under serious threat over the past century as the rise of fish farming, agriculture and the expansion of coastal cities and towns have seen mangroves chopped down and rapidly removed.

From the 1980s to 2010, over 12,000 sq km (4,600 sq miles) of mangroves were cleared or destroyed across Asia, Africa and the Americas – an area the size of Jamaica.

However, the new study shows a real reversal of that trend, particularly over the last decade. The total net losses – the forest lost and not replaced – since the 1980s have now been reduced to around 849 sq km (328 sq miles).

Restoration efforts over decades have helped degraded forests to recover, but the big change has come from the natural expansion of mangroves in many parts of the world following drops in deforestation.

This has enabled forest levels to stabilise in Indonesia and grow in Myanmar (formerly known as Burma) – two of the most mangrove-dense countries.

In Indonesia, the aftermath of the Indian Ocean tsunami in 2004 seems to have played a role in changing people's minds about the importance of mangroves, and the removal of trees for fish farming has slowed.

"Some islands were covered by mangroves and after the tsunami those islands were [still] protected very well, so that increased public awareness about the importance of protecting mangroves," said lead author Dr Zhen Zhang from Tulane University in the US.

A similar change in public attitude occurred in Myanmar after Cyclone Nargis in 2008 and a national logging ban in 2016.

Technology is also part of the answer, say the authors. For this study, a different satellite imaging system was used to map the forests in more detail, showing far greater numbers of new trees compared to previous studies.

This imagery came from the Landsat satellite "which is highly sensitive to canopy changes, and provides globally consistent observations that previous assessments may have missed," said Prof Elizabeth Robinson, director of the Grantham Research Institute, who was not involved with the study.

"This is a considerable advance on earlier global assessments," she told BBC News.

Some of the expanding growth, though, is likely to be double edged – it may be at the expense of environmental damage in other locations.

In many countries, including Brazil, new mangrove forests have taken hold along rivers and coastlines with an abundant supply of nutrients in the sediments.

But it has been the destruction of forests and mining further upstream which may have flushed the nutrients, like nitrogen, from soils into waterways, benefitting the mangroves down the river.

"This is good news for mangroves – there are more of them than we thought, and they are showing their resilience," said Dr Pete Bunting from Aberystwyth University, another of the authors.

"But it is only really good news if it is not a complete mess upstream."

The research also shows that whilst a combination of restoration and a reduction in chopping down mangroves has been successful, it has not been a uniform success across the globe.

West and Central Africa have emerged as hotspots of destruction.

"The Niger Delta is the poster child for mangrove pollution impact," said Bunting.

"Oil pollution is having massive impacts – and if you look at Google Earth you can see straight lines through the mangroves where the pipelines are."

Tropical cyclones also remain a serious threat – with storms responsible for some of the most dramatic single year losses recorded in the study, from Australia to the Caribbean.

Despite this, the authors agree this is a good news story.

"We are moving in the right direction because you can see a very clear trend of decreased loss rate," Dr Zhen Zhang told BBC News.

The study also found that many existing forests were actually becoming healthier. Since the 1980s, the proportion of closed canopy mangroves, the richest and most carbon-dense, has grown by nearly 20%.

"So, I think we are going the right way," said Zhen.

Sign up for our Future Earth newsletter to get exclusive insight on the latest climate and environment news from the BBC's Climate Editor Justin Rowlatt, delivered to your inbox every week. Outside the UK? Sign up to our international newsletter here.

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