Health Consequences of the Increasing Caesarean Section Rates

Abstract

Caesarean section (C-section) rates are rising in many middle- and high-income countries, with the justification that higher rates of C-section are associated with better outcomes. A review of 79 studies comparing outcomes of elective caesarean sections with vaginal deliveries, including both observational studies and randomized trials, suggests that caesarean sections may have substantially greater risks than vaginal deliveries. In this issue of Epidemiology, Leung and colleagues present data from Hong Kong on morbidity in offspring related to C-section. Such studies are needed to widen the scope of possible health outcomes related to elective C-sections, including such endpoints as maternal satisfaction and women's relationship with their child. Testing of interventions to reduce unnecessary C-sections is also needed, with strategies to enhance the role of women in the process of their obstetric care.

Caesarean Section Rate in a Tertiary Hospital in Makurdi, North-Central Nigeria

“…Several studies have shown an association between CS rate and maternal and infant mortality at population level in low income countries where large sectors of the population lack access to basic obstetric care [7,8,10]. The CS rate above a certain limit have not shown additional benefit for the mother or the baby, and some studies have even shown that high CS rates could be linked to negative consequences in maternal and child health [7][8][9][10][11].…”

Global implications of rising rates of cesarean sections and late preterm births

“…A similar rate was observed in the full-term infant population. This number is far greater than recommended by the World Health Organization (15%) 3 and is not explained alone by the described medical indications for CS. Elective CS played an important role in the high rates observed and require further evaluation to determine what percent were the result of previous non-medical indications.…”

Adverse neonatal and maternal outcomes in Pakistani tertiary care hospitals: A prospective, observational study

“…Practices fitting this description include routine episiotomy incisions, injudicious use of oxytocics, overuse of cesarean sections and artificial rupture of membranes (AROM) [29]. Unnecessary use of episiotomy incisions and cesarean sections and their associated risks to mothers and babies have frequently been noted in the literature [30,31]. In our study, one in every three women had an episiotomy incision, which included women with previous births.…”

“…AROM is generally recommended when there is fetal distress or some maternal indication so that the delivery process can be expedited [30,32]. We did not collect information on the indications for AROM for this study, but we believe that the high rate of this practice suggests unnecessary intervention.…”

“…We did not collect information on the indications for AROM for this study, but we believe that the high rate of this practice suggests unnecessary intervention. In a recently published study of 26 hospitals from eight developing countries, records were reviewed retrospectively to identify adverse events associated with healthcare management rather than the underlying disease process [30]. Reported adverse events ranged from 2.5% to 18.4% per country with nearly 30% resulting in death of the patient.…”