Women who give birth through caesarean operations without good medical reasons face massively increased risks, experts warned today.
A global analysis found that the risk of a woman dying or suffering serious complications increases when surgery is used for birth without proper reason.
The World Health Organisation experts said this meant caesareans should "only be done" when there are medical reasons.
The conclusions come from an analysis of more than 100,000 deliveries in nine Asian countries.
Some 122 hospitals and clinics were involved in the study – with caesarean section being used in more than one in four births.
Rates of caesarean were greatest in China, Sri Lanka, Vietnam and Thailand.
The findings are reported in The Lancet and show a 2.7 times increase in the risk of death or injury when a baby is born through planned caesarean – with no medical reason – compared with normal birth. This became a 14 times increase when an emergency operation was done during birth without adequate reason.
The researchers led by Dr Metin Gülmezoglu, of WHO, Switzerland, write: "Caesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby.
"Women and their carers who plan to undertake caesarean section delivery should discuss the potential risks to make an informed decision if they still wish to have a caesarean delivery."
The findings were backed by experts from the Women’s and Children’s Hospital, Singapore, writing in the same journal.
They say: "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary caesarean section."
The Royal College of Midwives said the study showed many women are being subjected to "unnecessary operations."
Deputy general secretary Louise Silverton said: "This is a significant international survey that emphasises the need to reduce caesarean section rates.
"This is a major surgical procedure, although most caesareans will be straightforward operations, there are potential complications for mothers and their babies and for subsequent pregnancies, which are outlined in the research, so the operations should only be performed for sound medical reasons."
She added: "There is now general acceptance among international maternity service providers that caesarean section rates are too high and should not exceed one in eight births."
The Lancet on-line January 12 2010
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