C-section use nearly doubles worldwide since 2000, study finds
A pregnant woman is examined as she waits to give birth at a public hospital in Rio de Janeiro on July 25, 2012. (AP Photo/Felipe Dana)
Nick Kirmse, CTVNews.ca Staff
Published Friday, October 12, 2018 12:17PM EDT
A new study has found that the number of births through caesarean section has almost doubled globally since 2000.
The study, published Thursday in medical journal The Lancet, found that the number of births through caesarean sections jumped from 16 million in 2000 to 29.7 million in 2015.
The caesarean section, or C-section, is a surgical procedure that sees the baby delivered through a surgical incision in the mother’s abdomen, rather than through the vaginal canal.
It’s a life-saving intervention, meant to be used when complications would make a conventional delivery dangerous to either the mother or child, but is increasingly used as a regular, scheduled procedure.
“Pregnancy and labour are normal processes, which occur safely in most cases,” series lead Dr Marleen Temmerman said in a press release. “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.”
Using data from the World Health Organization and UNICEF, researchers found that 21 per cent of births worldwide are delivered through caesarean, which is significantly higher than the level experts think require the procedure – around 10-15 per cent of births.
The information was published by the Lancet in a series of three papers, covering the reasons for the rising use of caesareans around the world, the long-term health risks associated with C-sections, and possible interventions to lower procedure rates.
C-section rates around the world
Of the 169 countries included in the study 15 of them, including Mexico, Brazil, and Turkey, have C-section use that exceeds 40 per cent of births, with the Dominican Republic having the highest figure worldwide with 58.1 per cent of births.
In North America, researchers found that C-sections are used in approximately 32 per cent of births, up from 24.3 per cent in 2000, with the United States at 32.9 per cent, and Canada at 26 per cent, up from 20.9 per cent in 2000.
Researchers found that C-section births around the world made up:
- 44.3 per cent of births in Latin America and the Caribbean
- 32 per cent of births in North America
- 29.6 per cent of births in the Middle East and North Africa
- 28.8 per cent of births in East Asia and the Pacific
- 27.3 per cent of births in Eastern Europe and Central Asia
- 26.9 per cent of births in Western Europe
- 18.1 per cent of births in South Asia
- 6.2 per cent of births in Eastern and Southern Africa
- 4.1 per cent in West and Central Africa
In these low and middle-income countries, researchers found that there is a great degree of disparity between economic groups, with wealthy women six times more likely to have a C-section than the country’s poorest women.
Researchers suggest that these disparities may be explained by persistent issues with shortages in healthcare facilities and staff in vulnerable and rural areas – a weakness they say needs to be addressed.
‘Risks that require careful consideration’
“In cases where complications do occur, C-sections save lives,” Temmerman said, “and we must increase accessibility in poorer regions, making C-sections universally available.”
But experts also warn that the increase in C-sections needs to come alongside a greater awareness of the health risks that accompany the procedure.
Risks associated with C-section, while rare, can be quite serious.
C-sections have a higher chance of maternal death and disability, as well as a more complicated recovery following the 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.
The study says that there is also emerging evidence that a C-section birth can subtly affect the health of a child, affecting their hormonal, physical and bacterial exposures during birth, which may increase the risk of allergies and asthma later in life.
“Given the increasing use of C-section, particularly cases that are not medically required, there is a crucial need to understand the health effects on women and children.” Professor Jane Sandall, one of the study’s authors, said in a release.
“C-section is a type of major surgery, which carries risks that require careful consideration.”
Joint action “urgently needed”
The rise in usage has prompted the World Health Organization to make a separate announcement, introducing new guidelines to try and reduce unnecessary C-sections, calling on healthcare professionals and organizations, as well as insurance companies and women’s groups to recommend non-clinical methods to pregnant women.
“The medical profession on its own cannot reverse this trend,” Prof. Gerard Visser of the International Federation of Gynecology and Obstetrics said.
The guidelines say that health education for women is a crucial step in reducing caesarean section births, recommending childbirth training workshops and relaxation training programs to help women conquer their fears of natural childbirth.
They also target healthcare professionals, calling for mandatory second opinions and the introduction of clinical practice-based guidelines for when caesarean births are recommended.
The study has already prompted responses from countries, with the Minister of Health of Brazil Gilberto Magalhães Occhi releasing a new country-wide strategy alongside the study to try and reduce the use of C-sections and ensure quality maternal health care.