Figures show substantial rise in proportion of C-sections

The proportion of Caesarean sections carried out in the UK has increased from 19.7% of births in 2000 to 26.2% in 2015, researchers have said.

A study published in The Lancet found that C-section use has almost doubled globally since 2000, from 12% to 21% of all births, higher than the level thought required for medical purposes (10-15%).

Researchers found 60% of countries were overusing the procedure and 25% under-using it, suggesting wide disparities in adherence to clinical recommendations.

They said that, while the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure tends to be overused in many middle- and high-income settings.

Within countries themselves, there are large differences between rich and poor, public and private sectors, and between regions, they found.

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

The global study, which involved several UK universities, is being presented at the International Federation of Gynaecology and Obstetrics (FIGO) World Congress in Brazil, where the authors are calling on healthcare professionals, hospitals, women and their families to only intervene with a C-section when it is medically required.

They said it can be a life-saving intervention for women and newborns when complications occur, such as bleeding, foetal distress, hypertensive disease, and babies in abnormal position, but the surgery is not without risk for mother and child, and is associated with complications in future births.

It is estimated that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

But they found that in at least 15 countries C-section use exceeds 40%.

Dominican Republic had the highest proportion (58.1%), followed by Brazil<br>and Egypt (both 55.5%), and Turkey (53.1%).

The South Asia region has seen the most rapid increase in use (6.1% per year), with C-section being underused in 2000 but overused by 2015 (increasing from 7.2% of births to 18.1%).

C-section use has remained low in sub-Saharan Africa, however.

Researchers, who used World Health Organisation (WHO) and Unicef data from 169 countries, also found 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.

They said it is important to note there are small but serious risks with C-sections, and that each of these risks increases the more times a woman has the procedure.

There is 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 the bacteria in the gut.

Professor Jane Sandall, of King’s College London, said: “Given the increasing use of C-section, particularly cases that are not medically required, there is a crucial need to understand the health effects on women and children.

“Greater understanding of this is important 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.

“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.”

Common reasons why women request C-sections include past negative experiences of vaginal birth, fear of labour pain or of the effects of labour such as pelvic floor damage, urinary incontinence, reduced quality of sexual functioning.

To address this, the authors recommend further research to study relaxation training, childbirth training workshops, educational lectures and brochures, and meeting with health professionals to promote supportive relationships, collaboration and respect.

Emeritus Professor Gerard Visser, of University Medical Centre Utrecht in the Netherlands, and chairman of FIGO’s Committee for Safe Motherhood and Newborn Health, said: “Worldwide there is an alarming increase in caesarean section rates.

“The medical profession on its own cannot reverse this trend.

“Joint actions with governmental bodies, the health care insurance industry, and women’s groups are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances.”

Mandy Forrester, head of quality and standards at the Royal College of Midwives, said it was important that women in the UK have access to all the available information on C-sections.

“There will always be women who for medical reasons need a caesarean, but there are many, as this research shows, which are not needed,” she added.

“What is crucial is that women are aware of the potential complications of having a caesarean section in the short and long term.

“To ensure this happens we need to give midwives the time to sit and discuss a woman’s options for the birth of her baby.

“It is very important that women make their decisions based on the best available evidence.”