The number of babies born through caesarean section almost doubled to 21% between 2000 and 2015, but in some countries, the rate is more than 40%, startling new figures show.
A Series of three papers, published in The Lancet and launched at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in Brazil, report that 63% of 169 countries recorded overuse C-sections, while 28% underuse the procedure.
It is estimated that ten to 15% of births medically require a C-section, but the procedure is used more than 40% of the time in at least 15 countries, say the authors. In 15 years, overall use of C-sections has risen from 12% to 21%.
The papers’ authors have called on healthcare professionals, hospitals, funders, women and families to only intervene with a C-section when it is medically required.
Series lead Dr Marleen Temmerman, Aga Khan University, Kenya, and Ghent University, Belgium, said the increase in C-sections in richer settings for non-medical purposes was concerning because of the risk to both mother and baby.
“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,” she said.
“In cases where complications do occur, C-sections save lives, and we must increase accessibility in poorer regions, making C-sections universally available, but we should not overuse them.”
The Series tracks trends in C-sections globally and in nine regions based on data from 169 countries from WHO and UNICEF databases.
It found that South Asia has seen the most rapid increase in use – from 7.1% of births being C-sections in 2000 to 18.1% in 2015.
C-sections are also overused in North America, which saw a rise from 24.3% to 32%; Western Europe, where C-sections have risen from 24.3% to 32%; and Latin America and the Caribbean, where 44.3% of births were C-sections in 2015, compared to 32.3% in 2000.
The World Health Organisation released new guidelines last night suggesting a range of non-clinical interventions to reduce unnecessary Caesarean sections. It suggests educational interventions and also the use of second opinions.
Professor Jane Sandall, of King’s College London, said a greater understanding of the health effects on women and their babies was needed to help inform decision making by families, physicians, and policy makers.
“C-section is a type of major surgery, which carries risks that require careful consideration,” she said.
“The growing use of C-sections for non-medical purposes could be introducing avoidable complications, and we advocate that C-section should only be used when it is medically required.”
Temmerman M et al. Optimising caesarean section use. Lancet 11 October 2018.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/fulltext
WHO Guidance: http://www.who.int/reproductivehealth/guidance-to-reduce-unnecessary-caesarean-sections/en/
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