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Thursday, January 14, 2010

WHO: All C-Sections “Put Women at Increased Risk of Adverse Events, Including Death”

by Jennifer Lance on January 14, 2010

There is no doubt that caesarean sections (c-sections) save mothers’ and babies’ lives, but the World Health Organization (WHO) has long declared this surgical procedure overused in many countries throughout the world. As we’ve reported before, the US c-section rate is 31.8%, half of those being elective procedures, and that rate continues to rise. WHO recommends “optimal cesarean section rates” to be between five and ten percent, with greater risks for women in countries whose percentages rise above 15.

Whether medically necessary or not, the latest information from WHO is that all caesareans “put women at increased risk of adverse events, including death”.

Why are more and more mothers in the US delivering their babies via c-sections given the risks or morbidity and mortality?  Childbirth Connection offers the following reasons:

  • Low priority of enhancing women’s own abilities to give birth
  • Side effects of common labor interventions
  • Refusal to offer the informed choice of vaginal birth
  • Casual attitudes about surgery and cesarean sections in particular
  • Limited awareness of harms that are more likely with cesarean section
  • Providers’ fears of malpractice claims and lawsuits
  • Incentives to practice in a manner that is efficient for providers

Published in the Lancet, the latest phase of the WHO’s Global Survey on Maternal and Perinatal Health Research Group reviewed births in nine Asian countries. China had the highest overall c-section rate of 46.2%, including 11.7% “without indication”. Medscape reports:

Any operative procedure increased the maternal mortality and morbidity index (defined as blood transfusion, hysterectomy, internal iliac artery ligation, or death or ICU admission) to a greater extent than spontaneous delivery…

Dr. Lumbiganon and associates maintain that “the most important finding of the survey is the increased risk of maternal mortality and severe morbidity…in women who undergo caesarean section with no indication.” The increased risk is primarily due to higher rates of ICU admission and blood transfusion.

“If this operation is limited to medical indications and unnecessary use is avoided, resources will be used for a need and will not be taken from other parts of the health system,” the authors write.

I am sure that you know at least one person that has delivered their baby via c-section. Some of these babies and mothers truly required the operation, but statistically, some of them did not. As the WHO study’s authors interpret, “To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.

WHO: All C-Sections “Put Women at Increased Risk of Adverse Events, Including Death”

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