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According to a study, the number of doctors practicing caesarean section to deliver children has almost doubled in 15 years and reaches "alarming" proportions in some countries.
Rates rose from about 16 million (12%) in 2000 to about 29.7 million (21%) in 2015, according to the medical journal The Lancet.
The country with the highest rate of recourse to surgery to facilitate delivery is the Dominican Republic with 58.1%.
Doctors say that in many cases the use of the medical procedure is unjustified.
Until recently, the World Health Organization (WHO) had suggested that caesarean section rates – or caesarean section rates – greater than 15% were excessive.
The study analyzed data from 169 countries using statistics from 2015 – the most recent year for which information is available.
What does the study say?
He says there is too much faith in cesarean procedures – when surgery is used to help a difficult birth – in more than half of the world's countries.
Researchers reported a rate of more than 50% in the Dominican Republic, Brazil, Egypt and Turkey, although Brazil implemented a policy in 2015 to reduce the number of caesareans performed by doctors.
They also found huge disparities in the use of technology between rich and poor countries. In some circumstances, particularly in sub-Saharan Africa, surgery is not available when it is actually required.
Use in 2015 was up to 10 times more prevalent in the Latin America and the Caribbean region (44% of births) than in the West and Central Africa region, where it was used only in 4 % of cases.
The study urges health professionals, women, and their families to choose a caesarean only when it is needed for medical reasons – and to provide more education and training to address some of the concerns surrounding childbirth .
What are the risks?
A caesarean section can be a rescue procedure for the mother and the baby if, for example, a baby is in an uncomfortable position in the uterus or if the work is not progressing properly.
Jane Sandall, a professor of social sciences and women's health at King's College London and author of one of the studies, told the BBC that the risk to the mother and baby could be at both short and long term.
"In particular, cesarean sections have a more complicated recovery for the mother and lead to a healing of the uterus, which is associated with bleeding, abnormal placenta development, ectopic pregnancy, birth to death and premature delivery during subsequent pregnancies. "
For Sandall Professor, it is important to note that these risks are small but serious, but each of these risks increases each time a woman undergoes the operation.
"It is increasingly evident that babies born by cesarean section experience different hormonal, physical, bacterial, and medical exposures during delivery, which can subtly alter their health." Although the long-term risks of this phenomenon are not well documented, the effects include changes in immune development that can increase the risk of allergies and asthma and alter bacteria in the intestine. "
"There is a risk associated with any type of surgery," Sandall said, adding that multiple caesarean procedures resulted in a higher risk of maternal death compared to a natural birth.
Earlier this week, WHO issued guidelines highlighting the need to reduce unnecessary procedures that "can not be medically justified".
"It is crucial that women who need a caesarean section can access this life-saving procedure," advised the WHO, adding that it was equally important to have a life-saving procedure. avoid unnecessary procedures "so that women and their babies are not endangered".
Why is surgery performed unnecessarily?
Prof Sandall says that the reasons vary from one country to another and that in the poorest countries, choices are extremely limited.
"Overall, the factors explaining the increase in rates vary from one country to another and include the lack of midwives to prevent and detect problems, the loss of medical skills to be able to attend. confidently and competently to a day's work. [potentially difficult] vaginal delivery, as well as medico-legal problems ".
She adds that there are financial incentives for doctors and hospitals with the certainty of deliveries scheduled for the day, especially in private practices.
"In some cases, the trend is dictated by the system: in Brazil, for example, the free public health care system is of poorer quality, and pregnant women who can not afford health care are private health could be offered the procedure to clean up patients more quickly through the system. "
"In China, a shortage of midwives can lead to a lack of screening, which means not only that the necessary medical check-ups are not performed, but also that expert assistance is not not enough to help with the delivery. "
According to Professor Sandall, there are differences in countries between rich city-dwellers giving birth in private institutions where caesarean section rates are high and the rural poor having no access to the procedure.
What can be done to improve things?
"The problem for women is how do you plan?" Prof Sandall says.
"An assumption that blames mothers for the high rate of caesarean section, either because of their poor health – obesity, hypertension for example – use of caesareans.
"Pregnant women need access to professional and enlightened advice to make a decision."
She added that the focus now needs to be on the assignment of more front-line staff to facilities in countries where the issue is of greatest concern.
"We need to start working with insurance companies in these countries to help with the provision of services and staff, as well as to deal with local and national governments to invest in health care. "
What is a caesarean section?
A cesarean section occurs during the delivery of a baby by performing a surgical cut in the abdomen and abdomen.
They fall into three categories:
- elective – at the request of the mother and sometimes for non-medical reasons
- expected – usually for medical reasons, for example if the baby is in the wrong position or in a very large
- urgency – usually because of complications during labor
Recovering from a caesarean section surgery usually takes longer than during a natural birth and can cause some discomfort in the days following the procedure. The wound ends up forming a scar.
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