Worldwide C-Section Births Rapidly On The Rise, Experts Call For Reduction

Grant Boone
October 14, 2018

The number of C-section births around the world has almost doubled since 2000, and only a fraction of those surgical procedures are medically necessary, according to a series of three papers published today by an global coalition of researchers from the World Health Organization, Yale University, King's College London and elsewhere.

Experts estimate that between 10 and 15 percent of births medically require a C-section due to complications such as bleeding, foetal distress, hypertension or a baby being in an abnormal position.

One in four United Kingdom babies is now delivered by caesarean section, new figures reveal as experts say women are increasingly scared of natural birth. The highest rate, of 58.1 percent, was in the Dominican Republic.

But in close to a quarter of nations surveyed, C-section use is significantly lower than average.

While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle- and high-income settings, said researchers, including those from Ghent University in Belgium.

'We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need, ' Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, said.

The authors of the study argue that in the world is held annually over six million cesarean section without objective evidence.

These include "a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend to a vaginal delivery, as well as medico-legal issues".

The study warned that in many settings young doctors were becoming "experts" in C-section while losing confidence in their abilities when it comes to natural birth.

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The study identified an emerging gap between wealthy and poorer regions within the same country.

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.

Globally, C-section use has increased by 3.7% each year between 2000-2015 - rising from 12% of live births (16 million of 131.9 million) in 2000, to 21% of live births (29.7 million of 140.6 million) in 2015.

The new study, based on data collected from World Health Organization and UNICEF, does not explain this dramatic increase in C-section births in some countries.

"C-sections can create complications and side effects for mothers and babies, and we call on healthcare professionals, hospitals, funders, women and families to only intervene in this way when it is medically required", Temmerman said.

Maternal death and disability rates are higher after C-section than vaginal birth.

It also leads to scarring of the womb, which is associated with bleeding, abnormal placenta development, ectopic pregnancy, stillbirth, and preterm birth in any subsequent pregnancies.

Looking at trends in Brazil and China where there is high use of C-section, the authors found that most C-sections were in low-risk pregnancies and in women who had previously had a C-section.

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