C-section births rise rapidly to more than 20 percent worldwide

Surgery in progress. /COURTESY

C-sections can save the lives of women and babies when there are birth complications such as fetal distress, or abnormal positioning.

The number of births by caesarean section has nearly doubled in the world in 15 years, from 12% to 21% between 2000 and 2015, exceeding even 40% in 15 countries.

The research tracked trends in C-section use globally and in nine regions based on data from 169 countries from World Health Organization and UNICEF databases.

Series authors estimate that more than one in four countries in 2015 had lower levels (28%, 47/169 countries) of C-Sections than medically recommended.

The US, Bangladesh, and Brazil reported C-section use in more than 25 per cent of births nationally, but some regions within these countries used C-section around twice as much as others.

"In cases where complications do occur, c-sections save lives, and we must increase accessibility in poorer regions, making c-sections universally available", says Temmerman, "but we should not overuse them".

In the article, the World Congress of Gynecology and Obstetrics in Brazil puts forward several hypotheses as to the reasons for this "epidemic", including a decline in the competence of the medical profession to accompany a potentially hard childbirth by natural means, the comfort of scheduling day births, and more attractive rates for doctors and clinics in case of caesarean section.

But at least 15 countries C-section use exceeds 40 per cent, research found.

Improvements have been slow across sub-Saharan Africa (around 2% per year), where C-section use has remained low, increasing from 3% to 4.1% of births in West and Central Africa, and from 4.6% to 6.2% in Eastern and Southern Africa.

"The large increases in C-section use - mostly in richer settings for nonmedical purposes - are concerning because of the associated risks for women and children", said Dr. Marleen Temmerman, lead author of three studies published October 11 in The Lancet.

In places such as Brazil and China, numerous c-sections performed were in women with low-risk pregnancies, in women who previously had c-sections, and in women who were well-educated.

But in close to a quarter of nations surveyed, caesarean section use is significantly lower than average. There is emerging evidence that babies born via C-section have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health.

Compared to vaginal births, C-sections can actually come with a higher chance of complications, a more hard recovery process and more risks during subsequent pregnancies, according to the report.

Dr Jane Sandall, professor of social science and women's health at King's College London and a study author, said there were a variety of reasons for women increasingly opting for surgery.

"Pregnant mothers must have access to professional and informed advice in order to make a decision".

'C-section is a type of major surgery, which carries risks that require careful consideration, ' said Sandall.

There is an urgent need for intervention in the medical field to reduce the use of cesarean sections, the researchers said.

The World Congress of Gynecology and Obstetrics (FIGO) advocates several measures to limit the abuse of caesareans: to apply a single rate for births, by caesarean section or not, to force hospitals to publish their statistics, to better inform women of the risks and improve training in natural birth. "Joint actions with governmental bodies, the health care insurance industry, and women's groups are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances".

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