Caesarean sections have almost doubled since 2000

The number of babies born through Caesarean section almost doubled between 2000 and 2015, rising from 12 per cent to 21 per cent, according to findings published in The Lancet.

About 10 to 15 per cent of births require a C-section due to complications and average C-section numbers should fall within this range.

However, in 2015, 106 out of 169 countries studied had C-section rates above this range, and in at least 15 countries, C-sections exceeded 40 per cent.

South Asia had the most rapid increase in such births, at a rate of six per cent per year.

In Africa, the operations rose by two per cent per year, with CS births increasing from three per cent to four per cent in west and central Africa; and from five per cent to six per cent in east and southern Africa.

In contrast, the operations were overused in North America, Western Europe, Latin America and the Caribbean, where rates have increased by around two per cent per year.

Even in low-and middle-income countries where C-section rates are low, there were disparities across socio-economic groups, with the wealthiest women being six times more likely to have a C-section. Moreover, C-sections were almost twice as common in private facilities than in public facilities.

A C-section is an intervention to save the lives of women and newborns when complications such as bleeding, foetal distress, hypertensive disease and babies in abnormal position occur, but the surgery is not without risk for mother and child, and is associated with complications in future births.

In cases, where there is no medical indication for a C-section, women and babies can be harmed or die from the procedure, especially if there are not enough facilities, skills and care available.

COMPLICATIONS

Maternal death and disability is higher after C-section than vaginal birth, and C-sections have a more complicated recovery period for mothers, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies.

Researchers say that it is important to note that these are small but serious risks, but each of these risks increases as a woman has more C-sections.

There is also emerging evidence that babies born via C-section have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health.

While the long-term risks of this are not well-researched, the short-term effects include changes in immune development which can increase the risk of allergies and asthma and alter bacteria in the gut.

“Pregnancy and labour are normal processes, which occur safely in most cases. The large increase in C-section use mostly in richer settings for non-medical purposes is alarming because of the associated risks for women and children. 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,” said series lead Marleen Temmerman from the Aga Khan University Hospital, Kenya and Ghent University, Belgium.

“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.”

Women commonly request C-sections due to past negative experiences of vaginal birth, fear of labour pain or of the effects of labour such as pelvic floor damage, urinary incontinence or reduced quality of sexual functioning.