Correlation of Cesarean rates to maternal and infant mortality rates: an ecologic study of official international data

Abstract

There is an inverse exponential relation between countries' rates of Cesarean deliveries and infant or maternal mortality rates. Very low Cesarean rates (less than 15%) are associated with poorer maternal and child outcomes. Cesarean rates greater than 15% were neither correlated to higher maternal nor child mortality, nor to low weight-at-birth.

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

“…After adjusting for HDI, the significant and negative association between caesarean section rate and mortality was observed when the caesarean section rate was lower than around 10%. The inflection point appears lower than the numbers reported by other investigators 4, 13, 16, 17, 18…”

“…In an attempt to identify such a caesarean section rate, several ecological studies have analysed the association between mode of delivery and maternal, neonatal and infant mortality 2, 4, 12, 13, 14, 15, 16, 17, 18. They used different statistical methods for the analysis (e.g.…”

“…They used different statistical methods for the analysis (e.g. piecewise regression, exponential models, quadratic models, locally weighted scattered plot smoothing, and fractional polynomial regression models), and found a nonlinear relationship between caesarean section and maternal, neonatal, and infant mortality 2, 4, 13, 17, 18. It was observed that high caesarean section rates were associated with lower maternal and infant mortality till a specific point, above which caesarean section rates were not significantly associated with these outcomes.…”

“…This inflection point was considered as a necessary caesarean section rate from a medical viewpoint to minimise mortality; however, the results and interpretations of these studies were limited by the cross‐sectional nature of the ecological data. Moreover, most of these studies did not control for socio‐economic conditions, which can have a great impact on both the availability of caesarean section and maternal and perinatal mortality, and thus confound the association between caesarean section rates and adverse outcomes 2, 12, 13, 16, 17, 18. We therefore set out to compile available caesarean section rates worldwide at the country level, and assess the association between mode of delivery and maternal and neonatal mortality using a longitudinal approach and adjusting for socio‐economic development.…”

266 Association of caesarean section and neonatal death: a population-based case–control study in Islamic Republic of Iran

“…In a study in Latin America, an increase in the caesarean section rate in the range 10-20% accompanied an increase in the neonatal mortality rate (9). Another study carried out in 193 countries from 2000-09 showed that in countries where the caesarean section rate was lower than 15% caesarean section delivery was negatively associated with neonatal mortality rate, while in the countries with caesarean section rates higher than 15% the association was positive (10). In addition, the caesarean section rate and neonatal mortality rate were not associated in high-and middle-income countries, while there was a negative association between the two rates in lower income countries, as reported by a study carried out in 119 countries from 1991 to 2003.…”