Caesarean sections can be a lifesaving procedure for many women and their babies, however, there has been a global increase in the number of c-sections carried out in recent decades without a correlating increase in positive outcomes for mothers and babies, suggesting that many of these c-sections are unnecessary. This is an issue affecting millions of women worldwide, with the World Health Organisation (WHO) estimating the current caesarean birth rate to be around 21% globally.
Why has there been an increase in c-sections?
It is thought that there are multiple factors contributing to the rise in c-sections. More women are now giving birth in hospital settings than ever before, which naturally increases the likelihood of medical interventions.
Additionally, we are living in a more litigative society, which makes many healthcare providers risk-averse, and means some doctors may be more inclined to offer a c-section rather than allow labour to continue to progress naturally.
In private healthcare, there is also a greater financial reward for performing a caesarean versus a normal vaginal delivery and a greater degree of control over work schedules, which may also make some healthcare providers keen to offer c-sections to their patients. Studies have even shown that c-sections are more likely to take place at certain times of day, corresponding to a doctor’s working day, with intervention more likely just before mealtimes or the end of a shift.
What are the risks from unnecessary c-sections?
Caesarean birth comes with inbuilt risks for mother and baby, but in cases where a c-section is warranted, these are often outweighed by the risks of not doing the surgery. When a c-section isn’t medically necessary, there are no health benefits and outcomes are worse for both women and babies.
Caesarean birth has risks that would be expected of any abdominal surgery such as bleeding, infection, increased risk of blood clots, problems with the anaesthetic and accidental damage to other tissues or organs. Problems faced by women giving birth via c-section include wound infections, womb infections, nerve damage and bladder damage. If the woman didn’t want the caesarean there can also be negative effects on her mental health and wellbeing. In addition, some women even need a hysterectomy, which can have a profound effect on their quality of life moving forward.
Even women who have a straightforward recovery from their c-section can discover later down the line that the surgery may have affected their fertility and can have an impact on subsequent pregnancies and births.
Babies born via c-section also face increased risks. They are more likely to have breathing problems in the days following birth. Babies can also be injured during a c-section if they are nicked by the surgeon’s scalpel during the procedure.
Women who feel they may have had an unnecessary c-section can pursue medical negligence claims for compensation.
How can c-section rates be reduced?
The World Health Organisation (WHO) stresses that education and information for women is key to reducing the rate of caesarean birth.
WHO recommends childbirth workshops and programs for pregnant women to address their fears and anxieties about childbirth. They also stress the need for regular audits of c-section practices and where possible, suggest that a second medical opinion should be sought before carrying out a caesarean.
Pilot studies are also underway to see if a collaborative midwife-led model of care can reduce c-section rates or if equalizing fees for natural childbirth vs c-section in fee-paying settings has an impact on caesarean rates.
In Summary
The rate of caesarean birth is rising globally, however, unnecessary c-sections pose risks for women and their babies. Evidence-based education for pregnant women and thorough audits of maternal healthcare providers may help lower the overall caesarean rate and improve outcomes.
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