Variation in caesarean section rates What difference does it make?

Joffe, Michael

doi:10.1136/bmj.308.6929.654

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Studies have found a higher likelihood of CS among shorter mothers ( 19 ) and younger mothers with a small pelvis ( 20 ). Mothers having better socioeconomic status ( 21 ), belonging to upper social classes, highly educated ones, and living in urban and metropolitan areas are more likely to prefer CS ( 22 – 28 ). The high prevalence of national CS is predominantly due to the excessive rate of CS triggered by the richest population living in urban areas in South Asia as well as other low-middle-income countries ( 29 , 30 ).…”

Section: Introductionmentioning

confidence: 99%

Risk factors of caesarean deliveries in urban–rural areas of Bangladesh

Abdulla¹,

Rahman

et al. 2023

Front. Reprod. Health

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Background and aimsThe key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh.MethodsThis study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model.ResultsCS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45–49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67).ConclusionThe findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.

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Section: Introductionmentioning

confidence: 99%

Risk factors of caesarean deliveries in urban–rural areas of Bangladesh

Abdulla¹,

Rahman

et al. 2023

Front. Reprod. Health

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“…Although cesarean delivery can be a life-saving surgery, this procedure should be performed only when medically indicated, as complications that have adverse consequences for the mortality and morbidity of both the mother and the newborn are well documented in the literature. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Some of the negative health outcomes in infants born via cesarean delivery include childhood obesity, respiratory disorders, type 1 diabetes, acute lymphoblastic leukemia, impaired cognitive development, higher rates of autism, and an increased risk of neurodevelopmental disorders. 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Cesarean delivery has been reported to be associated with an approximately 4-fold increase in the risk of maternal death.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

et al. 2020

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Key Points Question Are private vs public sector health care facilities associated with increases in cesarean delivery rates among pregnant women in India over time, and what is the avoidable burden of cesarean deliveries in private sector facilities? Findings In this cross-sectional study of 217 976 births at public and private sector institutions in India between 2005 and 2016, the likelihood of having a cesarean delivery in a private facility more than doubled over the period examined. A reduction in the percentage of cesarean deliveries in the private sector to the World Health Organization’s recommended threshold of 15% was associated with a potential cost savings of approximately $321 million. Meaning The study’s findings indicated that private sector facilities were associated with increases in the rate of cesarean deliveries; it is important that policy makers address the increasing number of avoidable cesarean deliveries in India.

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“…20Some studies place the relative risk of death from caesarean at 3.8 (Schuitemaker et al [54]) and others at 4.5 (Hall [24]).…”

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confidence: 99%

Why the Elective Caesarean Lottery is Ethically Impermissible

Romanis

2019

Health Care Anal

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In the United Kingdom the law and medical guidance is supportive of women making choices in childbirth. NICE guidelines are explicit that a competent woman’s informed request for MRCS (elective caesarean in the absence of any clinical indications) should be respected. However, in reality pregnant women are routinely denied MRCS. In this paper I consider whether there is sufficient justification for restricting MRCS. The physical and emotive significance of childbirth as an event in a woman’s life cannot be understated. It is, therefore, concerning that women are having their wishes ignored, and we must ascertain whether the denial of agency is justifiable. To answer this question I first demonstrate that access to MRCS is a lottery in the UK. Second, I argue that there is nothing unique about pregnancy that displaces the ethical norm of respecting patents’ sufficiently autonomous choices. Thus, the starting presumption is that all informed choices regarding MRCS should be respected. To ascertain whether any restriction of MRCS is justifiable the burden of proof must be placed on those who argue that MRCS is ethically impermissible. I argue that the most common justifications in the literature against MRCS are insufficient to displace the presumption in favour of autonomous choice in childbirth. I conclude that MRCS should be available to pregnant women, and we must strive to reduce the lottery in access to choice.

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Variation in caesarean section rates What difference does it make?

Cited by 6 publications

References 11 publications

Risk factors of caesarean deliveries in urban–rural areas of Bangladesh

Risk factors of caesarean deliveries in urban–rural areas of Bangladesh

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

Why the Elective Caesarean Lottery is Ethically Impermissible

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