Caesarean sections around the world are rising at a rapid rate, according to a report by an international team of doctors and scientists.
Since 1990, C-sections have jumped from about 6% to 21% of all births, and there are no “signs of slowing down,” the researchers write in a commentary about the studies.
C-sections have overtaken vaginal deliveries in parts of southeast Europe, Latin America, and China. Even in poor countries, the rates can be extremely high at clinics. In Bangladesh, less than 60% of births occur at a clinic, but when they do, about 65% of them are C-sections.
Private clinics have even higher rates. In Brazil, 80-90% of births in private clinics are C-sections, compared to about 30-40% of births in public hospitals.
“Such high rates are due mainly to an increase of elective C-sections”, says Salimah Walani, the vice president of global programs at March of Dimes, a U.S. maternal and child health organization.
“The procedure is done when it is not really necessary or indicated,” she says.
Walani stresses that the surgical procedure can do more harm than good for moms and babies.
For a mom, an elected C-section can raise the chance of death by at least 60%, and in some circumstances as much as 700%. It also increases a woman’s risk of life-threatening complications during childbirth, such as bleeding, uterine rupture, hysterectomy, and cardiac arrest by up to 500%, and extends to subsequent deliveries.
For babies, C-sections increase the risk of obesity and autoimmune diseases later in life. When the procedure occurs before 39 weeks, an early birth increases the infant’s risk of respiratory problems.
Three factors have been hypothsised to fuel the increase in global c-section rates: financial, legal and technical.
“As an obstetrician told me … ‘You’re going to pay me more [to do a C-section], you’re not going to sue me and I’ll be done in a hour,’ says Holly Kennedy, a professor of midwifery at the Yale School of Nursing and contributed to one of the studies.
When it comes to C-sections, there seems to be an undecided optimal rate that provides the most benefit to women and babies, a rate that probably depends on the location. The World Health Organization suggests it lies between 10 and 15%, while a more recent study found it is a little higher, around 19%.
North America and Western Europe are well above this optimal rate, with 3% and 27% of babies in 2015 delivered by C-section, respectively. The only region with a higher rate than North America is Latin America and the Caribbean, where 44% of all deliveries were C-sections in 2015.
To bring these rates down, hospitals need to pay doctors equally for vaginal births, a team of researchers write in a commentary.
At the other end of the spectrum, sub-Saharan Africa is still struggling to give moms access to C-sections when required. Across this region, the C-section rate has changed very little since 2000, plateauing at around 5%.
