Caesarean section births rise rapidly to more than 20% worldwide

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New research published in The Lancet has shown that rates of caesarean section births worldwide have nearly doubled to 21% between 2000 and 2015, with often life-saving surgery unavailable to many women in poor countries while often over-used in richer ones.

The research paper, Global epidemiology of use of and disparities in caesarean sections, found that 60% of countries overuse caesarean sections (CS) and 25% under-use them, suggesting that recommendations for their use in cases of medical need are widely ignored. In at least 15 countries, more than 40% of all babies born are delivered by CS. The highest rate, of 58.1%, was in the Dominican Republic.

While the procedure can save lives – of both mothers and newborns – it can also create complications and side effects, including higher risks for future births. CS births can lead to scarring of the womb, which is associated with bleeding, abnormal placenta development, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies. Several studies have shown a link between birth by CS and an increase in a variety of health disorders in children, such as asthma, eczema, diabetes, obesity etc. The fact that babies miss coming through the bacteria-rich vagina when born by CS may influence the seeding of a healthy microbiome. CS may also switch off or silence certain genes associated with immunity in the child. There are also cumulative health effects for women in subsequent pregnancies and later in life.

Experts estimate that between 10% and 15% of births medically require a CS due to complications such as bleeding, foetal distress, hypertension or a baby being in an abnormal position.

The International Federation of Gynecology and Obstetrics (FIGO), the International Confederation of Midwives (ICM), and the World Health Organization (WHO) have all flagged concerns about the rising caesarean section (CS) rate. FIGO has stated that there should be a focus on delivering "naturally and normally as far as possible”. In 2015, the WHO stated that there was no evidence of benefit when the CS rate went above 15%.

"The large increases in CS use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children," said Marleen Temmerman, an expert from Aga Khan University in Kenya and Ghent University in Belgium, who co-led the research. She called on doctors, midwives and other health workers "to only intervene in this way when it is medically required".

The research tracked trends in CS use globally and in nine regions based on data from 169 countries from World Health Organization and UNICEF databases. It found that globally, CS use has increased by 3.7% per year between 2000 and 2015 – rising from 12% of live births in 2000, to 21% in 2015. The pace of change varied widely between regions, with rapid increases seen in South Asia and much slower rises in Africa. CS continues to be over used in North America, Western Europe and Latin America and the Caribbean.

In Queensland the rates of women having a caesarean section giving birth for the first time have remained fairly static over the past decade, hovering around 28%, based on the latest 2016 figures. For Australia, the latest evidence suggests 34% of women who give birth have a caesarean section CS. That’s higher than the OECD average (28%), and a lot higher than Iceland, Finland, Sweden and Norway (15-17%), a set of countries with the lowest maternal and perinatal death rates in the world.

Globally, common reasons why women request a CS include past negative experiences of vaginal birth, fear of labour pain or of the effects of labour such as pelvic floor damage, incontinence and reduced sexual function.