Wednesday, 21 November, 2018

C-section births doubled globally since 2000: Lancet

Britain is among the highest users in Western Europe Britain is among the highest users in Western Europe Credit Telegraph
Melissa Porter | 15 October, 2018, 05:52

Caesarean section birth rates have almost doubled in two decades worldwide, even reaching "epidemic" proportions in some countries, doctors warned Friday.

It says there is an over-reliance on Caesarean section procedures - when surgery is used to help with a hard birth - in more than half of the world's nations. "The large increases in C-section use - mostly in richer settings for non-medical purposes - are concerning because of the associated risks for women and children", said Series lead Marleen Temmerman from Aga Khan University in Kenya and Ghent University. Rates have increased the most sharply in South Asia, where C-sections accounted for 7 percent of births in 2000 - an underused rate - but have since risen to more than 18 percent of births in 2015. C-sections are traditionally reserved for circumstances that include prolonged labor, placenta abnormalities, cord prolapse, distress of the fetus, certain diseases and if the baby is in an abnormal position.

Prof Sandall says it is important to note that these are small but serious risks, but each of these risks increases with each time a woman undergoes the surgery.

But at least 15 countries C-section use exceeds 40 per cent, research found.

"C-section is a type of major surgery, which carries risks that require careful consideration", says Jane Sandall, an expert on maternal health at King's College London.

There were not only different C-section rates between countries but also within them according to women's socio-economic status and access to medical facilities.

In other words, the surgery should be used sparingly.

Experts estimate between 10 and 15 percent of births medically require a caesarean section.

Today, however, many countries are failing to meet this recommendation - which is not ideal but does provide guidance.

The studies, which considered C-section trends in 169 countries, found an increase of 3.7% each year between 2000 and 2015.

Improvements have been slow across sub-Saharan Africa (around 2% per year), where C-section use has remained low, increasing from 3% to 4.1% of births in West and Central Africa, and from 4.6% to 6.2% in Eastern and Southern Africa. In some parts of the world, they actually outnumber natural births.

In places such as Brazil and China, numerous c-sections performed were in women with low-risk pregnancies, in women who previously had c-sections, and in women who were well-educated.

There were also significant disparities within low- and middle-income countries, where the wealthiest women were six times more likely to have a C-section compared with the poorest women, and where C-section was 1.6 times more common in private facilities than public facilities.

Earlier this week, the World Health Organization published guidance highlighting the need to reduce unnecessary procedures that "cannot be medically justified".

The information was published by the Lancet in a series of three papers, covering the reasons for the rising use of caesareans around the world, the long-term health risks associated with C-sections, and possible interventions to lower procedure rates. However, the trends reveal that more and more childbirths are being done via c-section, regardless of whether it is necessary or not.

But even those guidelines are likely to stir controversy, especially if they interfere with a woman's right to choose what happens to her own body.

The authors suggested better education, more midwifery-led care and improved labour planning as ways of ensuring caesarean sections are performed only when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.