Cesarean section, commonly referred to as a C-section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. It is usually performed when a vaginal delivery would put the baby or mother at risk. In recent decades, C-section rates have increased significantly in many parts of the world, raising concerns about overuse of the procedure.
What is the current C-section rate?
According to the World Health Organization, the ideal C-section rate is between 10-15%. However, global estimates indicate that C-section rates have risen dramatically from around 6% in 1990 to 21% in 2015. Rates vary widely between regions and countries. In the United States, over 30% of babies are now delivered via C-section, up from 20% in 1996. Other countries with high rates include Brazil (55%), Egypt (51%), Turkey (47%), Italy (38%), and China (34%).
Some of the lowest C-section rates are found in sub-Saharan Africa and parts of Asia. For example, C-section rates are only 3% in Chad, 5% in Nigeria, and 7% in India. However, experts believe the rates may be too low in some developing regions, putting mothers and babies at risk when medically necessary C-sections are not accessible.
Why are C-section rates increasing?
There are several factors driving the rise in C-sections globally:
- Maternal request – Some women choose elective C-sections for personal reasons like convenience or fear of natural birth.
- Increase in high-risk pregnancies – More advanced maternal age, obesity, chronic conditions like diabetes and hypertension increase complications requiring C-sections.
- Legal concerns – Doctors and hospitals may prefer C-sections to avoid risks of natural birth complications and lawsuits.
- Repeat C-sections – Most women who have had a previous C-section deliver via C-section again.
- Financial incentives – In some systems, C-sections are more lucrative for doctors and hospitals compared to vaginal births.
- Limited access to vaginal birth – Many regions lack facilities and providers focused on vaginal birth after C-section (VBAC) and non-medical inductions.
What are the risks associated with high C-section rates?
While medically necessary C-sections can be life-saving, overuse of the procedure when not indicated carries risks. Some concerns associated with high C-section rates include:
- Surgical risks for mother – Increased chances of infections, complications from anesthesia, heavy bleeding, blood clots, and problems with future pregnancies.
- Surgical risks for baby – Higher likelihood of rapid breathing problems, low APGAR scores, and accidental nicks during surgery.
- Slow recovery – Slower postpartum healing and mobility compared to vaginal birth.
- Breastfeeding challenges – Delayed lactation and decreased breastfeeding rates.
- Altered immunity – Babies do not receive immune-boosting benefits of vaginal birth.
- Higher costs – C-sections cost nearly 50% more than vaginal delivery.
For mothers, a C-section also increases the chances of potential complications and problems with delivery in subsequent pregnancies. There are also psychological effects, as some women experience emotions like disappointment or failure at not having a vaginal birth.
What is being done to reduce unnecessary C-sections?
In response to rising and disproportionate rates globally, many countries and health organizations are implementing interventions to reduce unnecessary C-sections, including:
- Implementing guidelines and quality standards – Establishing evidence-based clinical guidelines for when a C-section is medically justified.
- Education and informed consent – Educating expectant mothers on birth options and risks to enable informed consent.
- VBAC access – Improving access to vaginal birth after C-section (VBAC) through specialized providers and facilities.
- Labor companionship – Allowing doulas and companions to provide physical and emotional support for longer labors.
- Labor monitoring – Using tools like cardiotocography and fetal pulse oximetry to closely monitor labor and avoid unnecessary C-sections.
- Non-medical induction – Reducing elective inductions before 39 weeks that often fail, leading to C-sections.
- Payment and incentive reforms – Changing financial and quality incentives that favor C-sections.
Some places implementing these interventions have achieved noticeable declines in C-section rates. For example, the state of Vermont reduced rates from 34% to 25% between 1996 and 2013 using provider education, informed consent policies, and VBAC support programs.
What are target C-section rates in health care reform efforts?
Many countries and institutions are working to align C-section rates with the WHO-recommended target of 10-15%. For example:
- The United Kingdom – Aim of reducing national rate from 26% currently to 20% by 2025.
- Brazil – Goal of ensuring C-section rates of 20-30% in all regions by 2022.
- Ontario, Canada – Targeting a provincial C-section rate maximum of 18% by 2025.
- California Maternity Quality Care Collaborative – C-section rate goal of 23.9% for all participating California hospitals by 2022.
While the WHO target may not be realistic for all populations, getting closer to these benchmark rates represents significant progress in reducing unnecessary C-sections. Any decline without compromising maternal and neonatal outcomes is a step in the right direction.
Conclusion
Global C-section rates have risen exponentially in recent decades. Although medically justified in many cases, evidence shows that rates above 10-15% are associated with avoidable harms and costs. Through policy initiatives like guidelines, education, VBAC support, and payment reform, many countries are now working to safely reduce reliance on C-sections. While some settings may take longer to reach ideal levels, ongoing monitoring and quality improvement efforts focusing on necessary C-section procedures can help balance risks and benefits at both individual and population levels.