Worldwide, the proportion of babies delivered by caesarean section (C-section) has nearly doubled in the past decade and a half, and a worrying number of these procedures were performed unnecessarily, according to new research published in The Lancet. At the same time, the international team behind the paper found that many low-income nations and regions still lack adequate access to the surgery, which is often necessary to save the life of the child and the mother when pregnancy complications arise.
"Pregnancy and labour are normal processes, which occur safely in most cases. The large increases in C-section use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children,” lead author Dr Marleen Temmerman said in a statement. “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."
Using healthcare data from 169 countries that account for over 98 percent of the world’s births, Dr Temmerman and her colleagues calculated that, overall, C-sections were performed in approximately 21 percent of births (29.7 million) in 2015, compared to about 12 percent (16 million) in 2000. Past medical studies have suggested that 10 to 15 percent of deliveries require a C-section, yet 63 percent of countries showed C-section rates well above this threshold. The majority of these procedures were found to be performed for low-risk deliveries and for women who had previously had C-sections (which can make a subsequent vaginal delivery dangerous).
Alarmingly, there were at least 15 nations in which 40 or more percent of babies were born via C-section. The top spot went to the Dominican Republic (58 percent), followed by Brazil and Egypt (both 55.5 percent).
On the other hand, in 47 nations, the rates were stagnant and stayed at less than 10 percent, indicating that many women were denied this essential surgical intervention. In most cases, the low use of C-section was tied to maternal poverty and insufficient availability of medical care. South Sudan, where 82 percent of residents live in poverty, per The World Bank, showed the lowest rate – only 0.6 percent.
An accompanying commentary, written by representatives of the International Federation of Gynecology and Obstetrics, notes that many women request unnecessary C-sections due to fear of labor pain and the possible effects of vaginal delivery – fair concerns given that no one wants to experience agony, rip their perineum, become temporarily or permanently incontinent, or lose sexual functioning.
But even if C-section spares women some of the immediate difficulties of vaginal childbirth, the procedure is known to induce a longer recovery time and may result in uterine scarring, leading to a higher risk of bleeding, ectopic pregnancy, stillbirth, preterm birth, and abnormal placenta development during subsequent pregnancies. Moreover, babies born by C-section miss out on the vaginal microbiome coating that we now know to be key for immune system development. The short and long-term consequences of lack of exposure to these microorganisms is currently a hot topic in research.
"Although there is almost universal consensus that C-section use has increased beyond the reasonable level of need in many countries, effective interventions to optimise use have proven elusive,” stated Dr Ana Pilar Betran of the World Health Organization. “Interventions should provide a sense of empowerment for women, and will require meaningful conversations with health professionals, policymakers and advocacy groups to influence the discussion around maternity care.”