Can we reduce the caesarean section rate?

Robson, Michael

doi:10.1053/beog.2000.0156

Cited by 267 publications

(297 citation statements)

References 41 publications

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“…This finding conforms with the literature, as being nulliparous was identified as a contributor to the likelihood of a cesarean section [10,11] . In the present study, we established that women older than 35 years were more likely to have a cesarean section, which corresponds to results from recent research.…”

Section: Parity and Agesupporting

confidence: 91%

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Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

Maier¹

2015

JGNB

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Objective: The procedure of labor induction becomes increasingly important as the number of pregnancies requiring induction rises in the Western countries due to multiple reasons. In addition, a growing number of patients is aiming to achieve vaginal birth after cesarean section (VBAC). No pharmacological agent is licensed in this group of patients. A newly developed hydrophilic agent (Dilapan-S) is now available for cervical ripening, and is indicated also for patients with a previous cesarean section. Methods: Observational, non-interventional study in a tertiary perinatal center in Berlin, Germany in 2014. Eighty-three women at term with a singleton pregnancy and cephalic presentation were included. Results: In total, 60.2% of patients delivered vaginally, 4.8% by ventouse/forceps and 34.9% by secondary cesarean section. Parous women were found to have a significantly higher chance of vaginal birth (82.6% vs. 60.2% in total, p = 0.019). Patient's ≥ 35 years showed a tendency towards increased rates of ventouse and cesarean section (11.1% vs. 4.8% and 38.9% vs. 34.9% respectively). There was a tendency towards a higher rate of vaginal birth in patients with previous cesarean section (66.7% vs. 59.2%). No adverse fetal or maternal outcomes were noted. Conclusions:The application of Dilapan-S is cost-effective as patients can be seen in outpatient care. The device is efficient and safe. It is an attractive option for physicians and patients to lower the cesarean section rate by facilitating VBAC.

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Section: Parity and Agesupporting

confidence: 91%

“…Minimizing the interval to vaginal delivery is a key objective in every obstetric hospital with respect to labor induction [11] . When using the osmotic dilator, patients are seen as outpatients and can enjoy some time at home in a "safe environment" before the onset of labor.…”

Section: Time Interval To Deliverymentioning

confidence: 99%

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

Maier¹

2015

JGNB

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“…Caesarean section rates have risen substantially worldwide since the 1980s 1, 2, 3, 4. In some countries the rate has increased several‐fold since 1985, when the World Health Organization (WHO) suggested a caesarean section rate of 10–15% as the upper limit at the population level 5.…”

Section: Introductionmentioning

confidence: 99%

“…Although some less developed countries, mostly in Africa, still have the rate below 10%, the majority of the countries have surpassed this recommendation and some have exceeded it by a wide margin 1, 2, 4. The reasons for such dramatic increases are multifactorial, including medical as well as non‐medical reasons 3, 6, 7. It has been suggested that non‐medical factors, such as social, cultural, or unequal accessibility to health services, as well as clinical practice patterns/styles, might have been major contributors to the wide variation in caesarean section rates across different countries 1, 2, 6, 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

Zhang

Mikolajczyk

et al. 2015

BJOG

317

277

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ObjectiveCaesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality.DesignEcological study using longitudinal data.SettingWorldwide country‐level data.PopulationA total of 159 countries were included in the analyses, representing 98.0% of global live births (2005).MethodsNationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio‐economic development by means of human development index (HDI) using fractional polynomial regression models.Main outcome measuresMaternal mortality ratio and neonatal mortality rate.ResultsMost countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5–10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%.ConclusionsAlthough caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality.Tweetable abstractThe caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality.

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“…Since the 2000s, evidence shows that increasing numbers of women are requesting delivery by c-section. 17 A review of the literature on c-section requests highlights fear of poor or discriminatory care, lack of control in labour, pain, stress and anxiety as contributing to the desire for a c-section. 18 A WHO Survey conducted in 359 facilities worldwide found c-section rates in Asia ranging from 18.6% in Japan to 47.6% in China.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with caesarean sections in Phnom Penh, Cambodia

Schantz

Sim

Petit

et al. 2016

Reproductive Health Matters

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C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the overusage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge.

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Can we reduce the caesarean section rate?

Cited by 267 publications

References 41 publications

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

Factors associated with caesarean sections in Phnom Penh, Cambodia

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