A caesarean section is a potentially life-saving intervention for women and newborns when complications occur. While C-sections are still unavailable for many women and children in low-income countries and regions; the surgical procedure is overused in many middle-and high-income settings, according to a series of three research papers published in The Lancet.
The Series tracked trends in C-section use globally and in nine regions based on data from 169 countries from WHO and UNICEF databases. Globally, the number of babies born through caesarean section almost doubled between 2000 and 2015 from 12 per cent to 21 per cent, or one in five of all births, according to the series. They also noted that 60 per cent of countries overuse the procedure while 25 per cent of countries are unable to provide C-sections even when needed.
“Pregnancy and labour are normal processes, which occur safely in most cases,” said Professor Marleen Temmerman, lead author of the series and director of Aga Khan University’s Centre of Excellence in Women and Child Health in East Africa.
“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. 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.”
Researchers also found significant disparities within low- and middle-income countries, where the wealthiest women were six times more likely to have a C-section compared with the poorest women, and where C-sections were 1.6 times more common in private facilities than public facilities.
In an
accompanying comment, researchers noted that in many low-income and middle-income countries, C-section rates are too low in rural regions and in vulnerable groups, but are rapidly increasing in urban areas. In other words, there are areas in the same country with inadequate access to C-sections while other parts have too many C-sections taking place – a situation they summarised as “too little, too late and too much too soon.”
The World Health Organization estimates that between 10 per cent and 15 per cent of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.
Even though the medical community states that there are no benefits of C-section in cases without a medical indication, researchers noted that there is still a large demand for the surgical procedure due to sociocultural reasons, misconceptions that a C-section is safer for a baby, fear of litigation and concerns about the pain and after-effects of normal deliveries.
To address this, the authors recommend further research to study relaxation training, childbirth training workshops, educational lectures and brochures, and meeting with health professionals to promote supportive relationships, collaboration and respect. In addition, patient-centred care, organised by midwives and obstetricians, with birth companions of choice has been shown to be beneficial for women and babies. They added that all pregnant women need a nurse or midwife with some also needing a doctor/obstetrician.
“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,” said Professor Jane Sandall, of King’s College London, UK.
“The growing use of C-sections for non-medical purposes could be introducing avoidable complications, and we advocate that C-section should only be used when it is medically required.”
The findings of research have implications for global efforts to achieve the Sustainable Development Goals (SDGs). Targets under SDG 3 calls for steps to reduce maternal mortality and to end preventable deaths of newborns by 2030.
The Series received no funding and was conducted by researchers from University of Manitoba, London School of Hygiene & Tropical Medicine, Federal University of Pelotas, Catholic University of Pelotas, World Health Organization, Sichuan University, Ministry of Health, Brasília, Aga Khan University, Ghent University, University of Central Lancashire, Cochrane, São Paulo Federal University, Shanghai Jiao Tong University, Uganda Martyrs University, St Francis Hospital Nsambya, King’s College London, University of Papua New Guinea, Port Moresby General Hospital, International Federation of Gynecology and Obstetrics (FIGO), Burnet Institute, Yale University.