Caesarean section use has almost doubled globally since 2000

Globally, the number of babies born through the caesarean section (C-section) almost doubled between 2000 and 2015-from 12% to 21% of all births-according to a Series of three papers published in The Lancet and launched at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in Brazil. While the life-saving surgery is still unavailable for many women and children in low-income countries, the procedure is overused in many middle- and high-income settings.

C-section is a life-saving intervention for women and newborns when complications occur, such as bleeding, fetal distress, hypertensive disease, and babies in abnormal position. But, the surgery is not without risk for mother and child, and is associated with complications in future births.

It is estimated that 10-15% of births medically require C-section due to complications, suggesting that average C-section should be used between these levels. However, the Series estimates that more than one in four countries in 2015 had lower levels (28%, 47/169 countries), while most countries used C-section above the recommended level (63%, 106/169 countries). In at least 15 countries C-section use exceeds 40%.

"Pregnancy and labor are normal processes, which occur in most cases." The large increases in C-section use-mostly in richer settings for non-medical purposes. Dr. Marleen Temmerman, Aga Khan University, Kenya, says: "Lead Dr. Marleen Temmerman," says Dr. Marleen Temmerman, chief executive officer of the United States. and Ghent University, Belgium. "In cases where complications occur, C-sections save lives, and we can increase accessibility to regions, making C-sections universally available, but we should not overuse them."

Disparities in global C-section use

The Series tracks in C-section uses globally and in nine regions based on data from 169 countries from WHO and UNICEF databases. Globally, C-section 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 .

However, the pace of change varies substantially between regions. The South Asia region has the highest turnover rate (6.1% per year), with C-section being underused in 2000 but being overused by 2015 (increasing from 7.2% of births via C-section to 18.1%). However, improvements have been slow across sub-Saharan Africa (around 2% per year), where C-section is still 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).

C-section continues to be used in North America, Western Europe and Latin America and the Caribbean, where rates increased by around 2% per year between 2000-2015. C-section has grown from 24.3% to 32% between 2000-2015 in North America, from 19.6% to 26.9% in Western Europe, and from 32.3% to 44.3% in Latin America and the Caribbean.

The authors found that the global increases in C-section are more important in the treatment of C-section in health care (one-thirds of the increase) the increase).

C-section, the authors found that most C-sections were in low-risk pregnancies and in women who had previously had a C-section. In Brazil, particularly high levels of C-section were seen in women who were highly educated, compared with less educated women (54.4% of births vs 19.4%). The series is accompanied by a comment How from Gilberto Magalhães Occhi, the Minister of Health of Brazil, which sets the country's strategies to optimize C-section use (see link at end of press release).

In the 10 countries with the highest number of births in 2010-2015, there were large differences in C-section utilization between regions-for example, differences between provinces in China ranged from 4% to 62%, and inter-state differences in India ranged from 7% to 49%. The USA, Bangladesh, and Brazil reported C-section is used in other countries.

There were also significant disparities in low-and-middle income countries, where women were more likely to have a poor relationship with the poorest women, and were more likely facilities. The authors suggest that this is a problem that persists in rural populations.

In addition, in the UK C-section has increased from 19.7% of births in 2000 to 26.2% in 2015 (country-level data is available in links at the end of the press release).

Harms associated with C-section overuse and underuse

C-section maternal improvement, newborn and child survival when complications arise, and also the risk of incontinence and prolapse.

However, there are no C-sections for mothers and children, and there are no benefits of C-section in cases without a medical indication. In these instances, women and children can be harmed or die from the procedure, especially when there is sufficient capacity, skills, and health care available.

Maternal death and disability is higher after C-section than vaginal birth. In particular, C-sections have a more complicated recovery for the mother, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies. The authors say that it is important to note that these are small but serious risks.

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. While the long-term risks of this are not-well-researched, the short-term effects include changes in the immune system that can increase the risk of allergies and asthma and alter the bacteria in the gut.

"Increasing the use of C-section, which is not necessarily more important, it is a crucial need to understand the health effects of women and children. C-section is a type of major surgery, which carries the risk that the C-sections should not be used. when it is medically required. " says Professor Jane Sandall, King's College London, UK.

Tackling overuse of C-section

Common reasons why women request C-sections include negative experiences of vaginal birth, urinary incontinence, reduced quality of sexual functioning. To address this issue, the authors recommend further research to study relaxation training, childbirth training workshops, educational readings and brochures, and meeting with health professionals to promote supportive relationships, collaboration and respect.

For healthcare professionals, education, guidelines and communication, and second-opinion policies may also be useful to address these issues, such as convenience, financial incentives, and fear of litigation. In particular, in some regions, C-sections are seen as protective, and physicians are less likely to be present than during vaginal delivery.

The authors warn that they are becoming experts in C-section, while losing confidence in their abilities to assist in vaginal birth.

Clinical interventions are needed to reduce unnecessary C-sections, but there is a lack of research and investment in this area. Early indications that vaginal delivery is likely to occur, and vaginally attempting vaginal births, which have previously had C-sections may be helpful in reducing C-section use. In addition, some evidence suggests that it may be helpful to reduce the risk of premature labor.

"While there is almost universal consensus that C-section should be used in the past, it should be noted that C-section provide emotional support, policymakers and advocacy groups to influence the discussion around maternity care. Dr. Ana Pilar Betran, World Health Organization, Switzerland.

Also published in The LancetFIGO: How to stop the Caesarean epidemic section. This linked How to propose six recommendations to reduce unnecessary C-sections, including informing women of the benefits and risks of C-sections, matching costs for C-section and vaginal birth in private and public hospitals, and establishing their annual C-section rats. Emeritus Professor Gerard Visser, University Medical Center, The Netherlands, and Chair of the FIGO's Committee on Safe Motherhood and Newborn Health at FIGO writes: "Worldwide there is an alarming increase in this section (CS) rates. CSs and enable women and families and groups of women in the care of women and girls.

AT Lancet editorial published alongside the Series says: "What is left unresolved are the tensions generated when women's agency in a caesarean section goes against medical directives to intervene against them." Although the Lancet Series says that women's demand is not a substantial driver of the current problem NICE guidance in the UK, for example, states that a woman should be offered a planned course of action if she wishes. What does it mean to us, and what is new in this area?

Explore further:
Call for better counseling to women preferring cesarean births

More information:
The Lancet (2018). www.thelancet.com/journals/lan … (18) 31928-7 / fulltext