For decades, doctors have cautioned that women are having too many Caesarean sections, which is now one of the most common surgeries performed around the world. In spite of advice from public health officials that C-sections should be done only when medically necessary, but the statistics show that they are done too often and the rate of babies being delivered surgically is still well above target numbers.
Statistically, health officials believe the ideal rate of caesarean section births in a given country should be between 10 to 15 percent of all births. According to the World Health Organization (WHO), when countries have rates below 10 percent, the rate of deaths for mothers and babies escalates. However, they caution that there is no evidence too that rates of C-sections over 10 percent have any discernible effect on mother or child mortality, so there is a concern about the value of why they are being done so often.
The goal of delivering via C-section should be to safely deliver a baby when a vaginal delivery is not possible. There is a noticeable value in surgical deliveries when it comes to saving lives of babies and their mothers, according to Dr. Marleen Temmerman, who directs the WHO’s Reproductive Health and Research department. She also added that it is important “to ensure a Caesarean section is provided to the women in need – and to not just focus on achieving any specific rate.”
Rates vary greatly by country. The U.S. rate of C-sections in 2013, according to the U.S. Centers for Disease Control and Prevention (CDC) was nearly 33 percent of the 3.9 million deliveries. In Brazil, the rate is a whopping 52 percent of deliveries, whereas in the Netherlands and France, the rates are 15 percent and 21 percent respectively. In England, the rate is above 25 percent, which is twice what it was in the early 1990s.
The WHO cautioned that while delivery via surgery does save lives, when performed without medical need, C-sections put women and babies at risk of significant complications, disability or death. There could also be long-term effects, such as requiring the women to undergo future C-sections to deliver additional children.
Physicians should evaluate the need for C-sections on a case-by-case basis, the WHO said for the sake of the infant and woman. “Every effort should be made to provide Caesarean sections to women in need, rather than striving to achieve a specific rate,” according to a recent WHO report. For example, a C-section is usually recommended after prolonged labor, if the baby is in distress and if the baby is in a breech position. Additionally, women are generally advised to have planned Caesarean if they have experienced a complicated birth previously, are over 40 years old or have a medical condition that could complicate delivery such as diabetes, asthma or depression.
The world public health officials at the WHO proposes adopting an international Caesarean section classification system. The lack of a standardized worldwide approach for monitoring and comparing caesarean section rates using a consistent tool is one reason they believe there is such a widespread disparity in and lack of awareness of C-section rates.
The WHO proposed using the “Robson system.” That system classifies women right upon being admitted for delivery into one of 10 groups based on easily identifiable characteristics to determine early on the likelihood of needing a C-section. The characteristics include the number of previous pregnancies, gestational age, whether the baby is presenting head or feet first, previous uterine scarring, number of babies delivered previously and how this labour started. While the outcomes might not change, using a similar system worldwide would enable better comparison and analysis of Caesarean rates between medical facilities as well as across countries and regions.
By Dyanne Weiss