The ideal rate for caesarian sections (C-section) is 10%–15% as per the World Health Organization (WHO), since it is associated with a reduction in maternal and newborn mortality — higher C-section rates do not further correlate with reduced mortality rates.

 

 

According to the National Family Health Survey 2010–11, in India, the median C-section rate was 28% (private sector) and 5% (public sector). However, the more disturbing data comes from periodic studies from various cities and states, a sample of these data shows the C-section rates (CSR) are high: Karnataka (40%), Tripura (87%), Kerala (41%), Tamil Nadu (58%).

 

Medical Need vs Convenience

 

Medically, C-section is indicated when vaginal delivery might pose a risk to the mother or baby e.g. prolonged labour, foetal distress, placenta rupture, dystocia, suspected foetal compromise. Two well-established but debatable indications for C-section include for breech presentation and repeat caesarian section. Medically, the commonest cause of increased CSR is previous C-section.

 

Increased use of IVF has led to increased multiple births which usually require C-section. But non-medical factors like doctors’ preference and women’s demands too are responsible for the increasing trend.

 

Key Reasons for Increased C-sections Are:

 

Patients Perspective:

 

• Concern for mother or child’s life and health
• Healthcare provider’s competency and reassurance
• Convenience
• Fear of vaginal birth
• Previous birth experience

 

Doctors Perspective:

 

• It is a safe procedure
• Patients’ belief that they can deliver without painlessly
• Convenient scheduling to suit families and  healthcare professionals
• Strict monitoring of procedure
• Patients’ fear of urinary incontinence, poor sexual satisfaction post delivery or prolapsed uterus
• Desire for choice and control

      

 A uniquely Indian cultural practice driving up C-section rates is the ‘Muhurat Babies’ — a planned C-section trend, based on an auspicious date, among the middle and upper-class women across the country.

 

Pros and Cons of C-section

 

C-sections performed for non-medical reasons increase the risk of short and long-term health problems for the mother and child. 

 

On the other hand, natural (or vaginal) births involve physiological changes — absent or modified in C-section born infants — which impact the infant’s health.

 

Some of the deleterious effects of C-sections on the mother and/or child are:

 

• Increased risk of maternal morbidity
• Lengthy recovery period, restricted daily activities, breastfeeding difficulties
• Adverse psychological effects e.g. postpartum depression
• Future pregnancy risks: abnormal placentation, ectopic pregnancy, haemorrhage, latex allergy, implantation endometriosis, etc.
• Future childbirth risks (during subsequent pregnancies): uterine scar rupture, greater risk of stillbirth and neonatal morbidity
• Increased risk of admission to neonatal units, iatrogenic prematurity, and laceration
• Early term delivery is linked to increased neonatal respiratory problems and special educational need (SEN)

 

Combating the Threat

 

The advent of lower segment C-sections does not support the old adage of ‘once a caesarian, always a caesarian’. Most women with a previous C-section delivery should be encouraged to undergo a trial of labour. Research has shown that a mother’s pre-pregnancy BMI, newborn's birth weight, non-recurring indications of previous C-section, good Bishop’s score, and spontaneous onset of labour are predictors of success of vaginal birth after caesarian (VBAC), which carries a 0.5 to 1 % risk of a ruptured uterus.

 

The government and medical fraternity have woken up to the rising number of women undergoing C-sections to deliver babies. Government initiatives to reduce this liability include promotion of early diagnosis and management high-risk pregnancies to reduce caesarian sections. For citizens, a call to action includes initiation of an online petition that urges the Health Ministry to make it mandatory for hospitals and doctors to declare C-sec deliveries, conduct enquiries, and frame clear guidelines —  the petition amassed nearly 87,000 signatures within two weeks.

 

Learn more about this topic at:

 

1. WHO Statement on Caesarean Section Rates
2. The global numbers and costs of additionally needed and unnecessary caesarian sections performed per year: Overuse as a barrier to universal coverage