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.
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