Medical

C-section rates double in 15 years as WHO calls for worldwide reduction

C-section rates double in 15 y...
C-section rates have risen from 12 percent in 2000 to 21 percent in 2015, prompting calls for a reduction in unnecessary use of the procedure
C-section rates have risen from 12 percent in 2000 to 21 percent in 2015, prompting calls for a reduction in unnecessary use of the procedure
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C-section rates have risen from 12 percent in 2000 to 21 percent in 2015, prompting calls for a reduction in unnecessary use of the procedure
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C-section rates have risen from 12 percent in 2000 to 21 percent in 2015, prompting calls for a reduction in unnecessary use of the procedure

Three papers published simultaneously in The Lancet have revealed a striking rise in global rates of babies born through caesarean sections. The papers suggest that in middle- and high-income countries the procedure is significantly overused and many, including the World Heath Organization, are calling for a worldwide reduction in unnecessary use of the procedure.

Tracking trends in C-section use around the world, the report calculated overall rates nearly doubling in 15 years, from 12 percent of all live births in 2000 to 21 percent in 2015. The report also estimates that only around 10 to 15 percent of all births have a medical reason for a C-section, and the global average should roughly sit in between these levels.

Perhaps more striking are the localized trends in C-section rates. In 2015, 32 percent of births in North America were C-sections, but the highest rates were found in Brazil with a stunning 55.5 percent of births in the country using the procedure.

While this global trend is undeniably compelling, the authors behind the reports are calling for reductions in C-sections performed with no medical reason.

"The large increases in C-section use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children," says Marleen Temmerman, one of the researchers working on the project. "C-sections can create complications and side effects for mothers and babies, and we call on healthcare professionals, hospitals, funders, women and families to only intervene in this way when it is medically required."

However, outside of the acute complications that could arise from the surgical procedure itself, research is still generally unclear on what potential long-term effects a C-section can have on the health of a child. One of the three papers published in The Lancet explores the current body of evidence in this area and readily admits a lack of research into the later-life effects of a C-section on a person's long-term health. The paper does, however, point to a small body of research suggesting differences in babies born using C-section (CS) as opposed to vaginally.

"Infants born by CS have different hormonal, physical, bacterial, and medical exposures (such as intrapartum antibiotics and uterotonins) and are exposed to more short-term risks, which range from altered immune development, allergy, atopy, asthma, and reduced diversity of the intestinal gut microbiome, compared with those born vaginally."

Alongside this new research, the World Health Organization released a new guideline suggesting a series of non-clinical interventions that can be utilized to help reduce unnecessary C-sections. WHO recommends more educational interventions for women, and closer examinations into the reasons why health systems are aiding unnecessary surgical procedures.

"These guidelines are timely and needed," says Ana Pilar Betran, a medical officer working with WHO. "When we reduce unnecessary caesarean sections, we also reduce unnecessary risks to women and their babies. We also reduce unnecessary costs for hospitals and health systems."

The big challenging ethical question hovering above all this research is at what point should the medical community be more stringent about accommodating unnecessary C-sections? Stigmatizing the procedure itself could cause more harm than good, driving away women that genuinely need the procedure. A Lancet editorial accompanying the papers also suggests care must be taken in not stifling a woman's right to choose her own terms of birthing.

"What is left unresolved are the tensions generated when women's agency in choosing a caesarean section go against medical directives to intervene against them," the Editorial states. "Although the Lancet Series says that women's demand is not a substantial driver of the current problem of overuse, efforts to reduce caesareans must, nevertheless, strongly respect women's rights to choose the circumstances of birth."

The new papers are published in The Lancet.

Source: The Lancet via EurekAlert

5 comments
lauren57
C-section "is as much the act of birth, both for mother and babe, – thought they seemingly do finely, – as purchasing meat from a butcher called hunting,"
deltaroo
C-sections are primarily due to a genetic defect in the woman causing her to have very narrow hips that the baby is unable to pass through. Aside from the rising rates of obesity in the western world, the reason an increasing percentage of women are having C-sections should be fairly obvious. In the past, women and their babies that needed a C-section were far less likely to survive the birthing process, stopping the genetic defect from being passed on. Now, with the miracle of modern medicine, women that need C-sections are able to pass on their evolutionarily inferior genes to their offspring who are more likely to need C-sections when they reproduce as well.
Don Duncan
If hospitals are doing C-sections without a medical necessity and putting the baby/mother at increased risk, why would they do it and why would the parents let them? Answer: A surgeon/hospital profit financially. The parents let it happen on their doctor's advice, who withholds info. How do they get away with it? Answer: The AMA is powerful, individuals weak and naive. What about their oath: "First, do no harm"? Answer: You better pull your head out of your ass and take care of yourself or you're in for a tough life. If you don't care, no one else will. Do your own research and interrogate the doctor. Get a second opinion if you have any doubt.
This C-section abuse and much more has been going on for 50+ years. It won't stop until patients make it stop. Putting a collective fund (medical insurance) between the patient/provider is a big part of the problem.
Daishi
Outside of different health implications I would argue that there are emotional differences too. It is a completely different birthing process and experience. I think the emotional bond with children born through traditional process is different.
Eric Blenheim
Caesarian section is completely unnatural, and what if, in the future, only mothers with hips too narrow to give birth properly predominate? Without surgery, those women would surely die out. In Victorian times in England, 40% of pregnancies ended in death of the mother. Much of the cause may, in many cases, simply have been malnutrition, particularly in big cities. For instance, the average height of country dwellers who could obtain fresh food with ease was 5' 5" tall, but after those same people moved into cities like London, their height of the children that they produced there became only 5' tall on average, and those children had narrower hips and narrower jaws, making childbirth much more difficult for them.
The lungs of the baby in the womb are flat, and when the baby starts to move through the birth canal, a hormone makes the vascular system of the lungs start to pump up, ready to process air with haemoglobin to nourish the brain and other tissues with oxygen-bearing blood.
The Caesarian process may not allow this process to naturally take place fully, though injections are given before the Caesarian presumably to initiate that very process. However, maybe they get the timing wrong sometimes, as even children born naturally pass through the birth canal in differing times, some in minutes, some in several hours, but the umbilical cord during that time is constantly trying to prepare the lungs to receive air, and peristaltic motion is seen in the umbilical cord as long as this process takes place, usually for around 20 minutes or so after the child exists the birth canal, and it should never be severed during this time, as the child's lungs are still clearly being prepeared even then to be able to process air and bond haemoglobin with oxygen even during that time, but 95% of babies today suffer the brutal abrupt premature termination of that process by the almost immediate severing of the umbiical cord upon their exiting the birth canal or being born by Caesarian, and even two hundred years ago, doctors knew that severing the umbilical cord very prematurely in this way, before the lungs are even able to function to provide blood supply to the brain and CNS independently of the mother, would result in lifelong weakness in the child.