Rising trends and indication of Caesarean section in Indonesia

Abstract

The rate of Caesarean delivery is rising dramatically worldwide, and also nationally. The number of Caesarean births exceeds the WHO recommended rate. This study aims to provide an overview of current increasing trend of Caesarean section, including elective procedure, and its risk. A review was conducted using online database, surveillance reports, and national surveys to identify studies with topics of prevalence, trend, indications, and risks of Caesarean delivery. Overall, there is an increase of Caesarean section in global, Asia, and Indonesia setting. We found an increase of 8% from 2013 to 2018 based on population survey, and increase of elective Caesarean surgery, particularly in tertiary care. We listed the possible health risks in short term, long term among mothers and child. Advanced maternal age, higher socio-economic status, higher educational level, residing in urban area, and ownership of health insurance were found to be factors associated with maternal choice on Caesarean delivery. The information presented is important to raise awareness among policy makers aimed to develop a national strategy in reducing the rate of Caesarean delivery.

Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample

“…A recent study showed 40.5% CS in Latin America and the Caribbean region, 32.3% in Northern America, 25% in Europe, and 19.2% in Asia [ 13 ]. CS rates in some countries are significantly above the WHO recommendation limit, namely, the Dominican Republic (59.3%), Brazil (56.0%), South Korea (38.0%), and the United States (32.9%) [ 2 , 16 , 27 ].…”

“…Typically, maternal education has a more substantial effect on CS rates than paternal education [ 47 ]. Income levels also influence CS rates [ 9 , 48 , 50 ], alongside maternal obesity [ 11 , 13 , 46 ]. Mothers of several children are more likely to have a CS with their next child and have adverse consequences [ 1 , 51 - 52 ].…”

“…Nevertheless, a growing number of children are being born by surgical delivery globally in both developed and developing countries [13][14][15]. According to data collected from 169 countries, the global rate of CS was estimated to be almost doubled within 15 years, from 16.0 million in 2000 to 29.7 million in 2015, accounting for more than one in five live births [16].…”

“…These include maternal socio-economical determinants incorporating maternal age, residence, education, income, and the number of antenatal care (ANC) during pregnancy and other factors, including body mass index, number of children, the preceding birth interval, and media exposure [28][29][30]. Maternal age of fewer than 30 years [19][20][31][32][33] is considered to lower the risk of comorbidities associated with CS [34][35], with advanced maternal age, i.e., 35 years or more, found to significantly increase the rate of CS and adverse outcomes [1,13,30,34,[36][37]. With advancing age, the overall rate of CS doubles from 21% (<20 years) to 42% (≥35 years), enhanced by repeated pre-labour CS [28].…”

“…The mother's residence, especially in low-and middle-income countries (LMICs), appreciably impacts CS rates, increasing mothers in urban areas [9,46]. The level of education also appears to influence CS rates, with typically higher education levels associated with higher CS prevalence rates [1,13,15]. However, this is not always the case, especially in higher-income countries [30,[47][48][49].…”