A comprehensive review of section rates has shown that internationally there is an increase in cesarean sections since 2000. A publication to this effect came out in the Lancet. It is reviewed here by CNN.
The normal way a baby is born is through the vaginal birth canal. But with certain emergencies the physician in charge of the delivery may decide to end the delivery faster by doing a surgical cut through the abdomen into the uterus and removing the baby by a cesarean section. As far back as the 1980’s there has been an attempt by the obstetrical associations to keep the cesarean section rates low and encourage women to deliver vaginally. The reason is that there are less complications with vaginal deliveries, as long as the baby is not too large, so it will fit though the birth canal.
The study showing increase in cesarean sections since 2000
In 1985 the World Health Association (WHO) stated that there was “no justification for any region to have a cesarean section rate higher than 10-15%.” But in the present study many countries had a rate of 30% or more. In 2015 Canada and the US have had a rate of 32%. Latin America and the Caribbean have a rate of 44.3%. In contrast, West and Central Africa have a cesarean rate of only 4.1%. Eastern and Southern Africa had a cesarean section rate of only 6.2% of all births. East Asia and the Pacific had a cesarean section rate of 28.8%. In Western Europe 26.9% are born by cesarean section.
Comparison to the year 2000
In 2000 the section rate in North America was 24.3% and this jumped to 32%. East Asia and Pacific had a rate of 13.4% in 2000 and jumped to 28.8% now. Eastern Europe and Central Asia had a cesarean section rate of 11.9% in 2000 and now has a rate of 27.3%. West and Central Africa had a rate of 3% in 2000 and now has a rate of only 4.1%. Eastern and Southern Africa had a rate of 4.6% in 2000 and now has a rate of 6.2%.
Globally the cesarean section rate was 12.1% in 2000 and now is 21.1%.
What are the reasons for doing a caesarean section?
The most common reasons for an emergency cesarean section are: problems with the placenta or with the umbilical cord; if the baby’s heart rate changes suddenly indicating fetal distress; or the baby appears to be too big to fit through the birth canal. Another reason is breech presentation. These are legitimate reasons for a cesarean section. But sadly the convenience factor is playing a bigger and bigger role.
The convenience factor
The reason there has been such a jump of cesarean sections between 2000 and 2015 is the convenience factor. Cesarean sections are perceived as the easy way out as explained in this link. Women who get babies are now older and there can be more complications with deliveries. This can lead to more malpractice claims. By doing cesarean sections complications are more controlled. But there is another factor, namely that C-sections are twice as costly as vaginal deliveries. There is a moneymaking incentive for physicians. But some women are also reluctant to go through vaginal deliveries. Women cite a fear of labor pains, laxity of the vagina and uterine prolapse as the reason why they want a cesarean section.
Cesarean section rates have been increasing significantly in most countries around the world. Most obstetrical authorities say that a rate of 10 to 15% of cesarean sections would be justified by true emergencies. These could be cord prolapse, premature separation of the placenta, fetal/pelvic disproportion (baby’s head too large) and fetal distress leading to heart beat abnormalities. Physicians expect these types of complications leading to a cesarean section to remain constant.
It is the convenience factor that has driven up cesarean section rates. The cesarean section rate in North America was 24.3% in 2000 and jumped to 32% in 2015. Physicians worry about possible complications with vaginal deliveries in older patients. But physicians are also better paid for cesarean sections, as a matter of fact twice as much as for vaginal deliveries. There seems to be a financial incentive.
Vaginal deliveries have their risks, but in cesarean sections there are even more, like infection of the wound, scarring, and risks due to the epidural or general anesthetic.
The problem of high percentages of cesarean sections is not going away any time soon. Internal supervision of practicing physicians may gradually bring down the higher rates of cesarean sections.