Friday, 16 November, 2018

Doctors Warn Of C-Section ‘Epidemic’ As Global Rates Double

A pregnant women at a doctors office Modal Trigger Shutterstock
Johnnie Parks | 15 October, 2018, 05:56

Moroccan doctors carry a Syrian baby Siwar, who was born by caesarean section in a field hospital in Al Zaatari refugee camp in the Jordanian city of Mafraq, near the border with Syria, March 7, 2016.

They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates "that have virtually nothing to do with evidence-based medicine".

In 2015, the most recent year for which complete data is available, doctors performed 29.7 million caesarean operations worldwide - 21 per cent of all births. This was up from 16 million in 2000, or 12 per cent of all births, according to research published in The Lancet.

Using data from the World Health Organization and UNICEF, researchers found that 21 per cent of births worldwide are delivered through caesarean, which is significantly higher than the level experts think require the procedure - around 10-15 per cent of births.

The majority of these procedures were found to be performed for low-risk deliveries and for women who had previously had C-sections (which can make a subsequent vaginal delivery dangerous). The highest rate, of 58.1 percent, was in the Dominican Republic. C-section use has remained low in sub-Saharan Africa, however.

But the procedure is unavailable to many women in low-income countries and overused in many middle- and high-income countries, the researchers found.

In the article, the World Congress of Gynecology and Obstetrics in Brazil puts forward several hypotheses as to the reasons for this "epidemic", including a decline in the competence of the medical profession to accompany a potentially hard childbirth by natural means, the comfort of scheduling day births, and more attractive rates for doctors and clinics in case of caesarean section.

It's a life-saving intervention, meant to be used when complications would make a conventional delivery risky to either the mother or child, but is increasingly used as a regular, scheduled procedure.

Doctors are often tempted to organise caesarean operations to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.

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The study warned that in many settings, young doctors were becoming "experts" in caesarean births while losing confidence in their abilities when it comes to natural births.

The study identified an emerging gap between wealthy and poorer regions within the same country.

For example, in China, C-section rates ranged from 4 percent to 62 percent, while in India the range was 7 to 49 percent.

The study has already prompted responses from countries, with the Minister of Health of Brazil Gilberto Magalhães Occhi releasing a new country-wide strategy alongside the study to try and reduce the use of C-sections and ensure quality maternal health care.

"In cases where complications occur, cesareans save lives, and we need to promote women's access [to this intervention] in poor areas, but we should not abuse it".

In at least 15 countries, C-section use exceeds 40%, researchers said.

Some of the possible risks associated with c-sections may include bleeding, blood clots, surgical injuries to the mother's organs, infection, injury to the child, increased risks in future pregnancies, adverse reactions to medications, and breathing problems for the child especially when born before 39 weeks of pregnancy.

The global increase is mainly attributed to more births taking place in health institutions (about two thirds of the rise) where there is a greater frequency of intervention through C-section (one third of the increase).

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