WHY ARE C-SECTIONS ON THE INCREASE?

Written by Caroline Meyer

When looking at births worldwide, studies done on the period 2000 to 2015 shows an increase from 12% of births to 21% of births are occurring through C-section. Interestingly, this has not occurred due to improved conditions in developing countries as for many women in low income regions, the procedure is essentially unavailable. It is in the middle to high income countries that the procedure is becoming more common place. Caesarean sections are generally touted as a lifesaving intervention which is usually only used for complications such as hypertension, foetal distress, bleeding or baby being in an abnormal position that prevents him being delivered normally. This isn’t a catch all intervention and there are risks involved in c-sections as well. Just as in most surgeries, there are risks to the baby as well as the mom. There are also long-term complications associated with repeated C-section surgery. The complications that require a caesarean occur in around 15% of births. Why then is the level of C-sections so much higher. In some countries the incidence of C-sections is as high as 40% of births. 

Childbirth is a normal process which occurs naturally and quite safely in more than 85% of cases. The increase of C-sections among richer parents therefore seem to be occurring without any medical complication being present. While C-sections do offer an improved maternal and child survival rate in higher risk pregnancies, there are no actual benefits to mums who have C-sections that are not medically indicated. This actually raises the risk of complications and a higher risk of a negative outcome for mums and newborns especially in facilities that do not have adequate care and skills readily available. C-sections cause scarring to the womb which can result in issues such as abnormal placenta development, ectopic pregnancy, bleeding, preterm and stillbirths in later pregnancies. Disability and maternal death during C-sections are also higher than during vaginal birth when looking at a worldwide average. The risks of something going wrong increases after each C-section. The more Caesarians a woman has, the higher the risk of serious complications. 

There is also some evidence that babies that are born via a C-section may have different exposure to bacteria and hormones as well as different medical interventions that can alter their long-term health. The research on this is still ongoing, but proven short-term effects include altered bacteria in the gut, a different immune development than a vaginal birth baby and an increase in the risk of asthma and allergy development.  

Some of the reasons that women are requesting C-sections include bad experiences during previous labours, fear of pain, not wanting to risk pelvic floor damage or reduced sexual function or potential urinary incontinence. For healthcare providers there needs to be improved education in order to relay the potential risks of C-sections and benefits of vaginal birth to reduce C-sections done without a medical complication which specifically requires it. 

Medical facilities should have effective guidelines in place to ensure that mums-to-be are given enough knowledge in order to make informed decisions and that non-complication C-sections are discouraged. To allay fears, parents can attend labour and childbirth workshops, attend parenting and prenatal lessons and educational lectures. Offer second opinions so that parents get the benefit of experience from more than one doctor if needed.  

There are financial incentives to many facilities if C-sections are done as the patient stay is longer and the care costs are higher, resulting in extra funds. Doctors may also feel they cannot deny requests made for C-sections due to potential litigation. Sometimes C-sections are simply done for convenience for the doctor or the patient. With the increase in C-sections, many doctors are less confident attending vaginal births. By addressing the issue and perhaps improving education for the doctors and medical personnel, the rate in unnecessary C-sections may start to drop. There is even a suggestion that more women be allowed to attempt vaginal birth after having undergone a C-section previously if it is deemed safe.  Reducing other interventions in childbirth may also reduce the number of C-sections required. Planning births, relaxation training and adequate education may help mums feel more confident and more likely to try a vaginal birth as a first option with a C-section only being on the cards in the case of an emergency or a medical complication that demands it to reduce risk to mum or baby.