A series of studies published in The Lancet weekly medical journal said that the number of births by C-section has doubled in 15 years, with Latin America and the Caribbean leading the pack. Researchers warn that an optimum balance is necessary in the use of these procedures as their underuse may cause maternal or prenatal mortality and their overuse can pose numerous health risks to women and newborns.
In some cases, C-sections can save the life of the mother or the newborn. However, this, like any other surgical procedure, has inherent short and long-term risks that make it inadvisable unless it is absolutely necessary. The growing rate of C-sections across the globe is raising concerns among medical professionals, who are calling for clearer guidelines for the optimized use of these procedures as some countries underuse while others overuse them. While the rate of C-sections has grown worldwide, from 12.1 percent in 2000 to 21.1 percent in 2015, the rate at which this procedure is used varies widely by country. The lowest rate, 0.6 percent, belongs to South Sudan and the highest, 58.1 percent, to the Dominican Republic. Moreover, births by C-section vary widely within the same country, with the richest quintiles reporting about five times the rate of the lowest quintiles.
“The large increases in C-section use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children,” said Marleen Temmerman, Head of the Centre of Excellence in Women and Child Health at Aga Khan University. The risks associated with C-section are many. For mothers these include uterine rupture, stillbirth, ectopic pregnancy and abnormal placentation. For newborns, short-term risks include allergies, altered immune development, atopy, asthma and reduced gut microbiome diversity. In the long term, those born by C-section have been shown to be at greater risk for obesity and asthma.
As a whole, Latin America has the highest C-section rate globally. Mexico is among the Top 15, with 40.7 percent of all births, about three times WHO’s recommended rate of 10-15 percent of all births. Women at a higher risk of undergoing an unnecessary C-section are first-time mothers, over 35 years of age, use private healthcare and live in metropolitan areas.
While pregnant women and their doctors in richer areas seem to increasingly prefer C-sections, these studies warn that the dangers these procedures represent are often overlooked. They call for higher consideration of the short and long-term outcomes for both mother and child when making the decision on how to give birth.