Doc­tors warn C-sec­tions are at ‘epi­demic’ pro­por­tions glob­ally

Doc­tors tempted to or­ga­nize C-sec­tions to ease flow of pa­tients

Kuwait Times - - Health & Science -

PARIS: World­wide Cae­sarean sec­tion use has nearly dou­bled in two decades and has reached “epi­demic” pro­por­tions in some coun­tries, doc­tors warned Fri­day, high­light­ing a huge gap in child­birth care be­tween rich and poor moth­ers. They said mil­lions of women each year may be putting them­selves and their ba­bies at un­nec­es­sary risk by un­der­go­ing C-sec­tions at rates “that have vir­tu­ally noth­ing to do with ev­i­dence-based medicine”.

In 2015, the most re­cent year for which com­plete data is avail­able, doc­tors per­formed 29.7 mil­lion C-sec­tions world­wide — 21 per­cent of all births. This was up from 16 mil­lion in 2000, or 12 per­cent of all births, ac­cord­ing to re­search pub­lished in The Lancet. It is es­ti­mated that the op­er­a­tion-a vi­tal sur­gi­cal pro­ce­dure when com­pli­ca­tions oc­cur dur­ing birth-is nec­es­sary 10-15 per­cent of the time.

But the re­search found wildly vary­ing coun­try rates of C-sec­tion use, of­ten ac­cord­ing to eco­nomic sta­tus: in at least 15 coun­tries more than 40 per­cent births are per­formed us­ing the prac­tice, of­ten on wealth­ier women in pri­vate fa­cil­i­ties. In Brazil, Egypt and Turkey, more than half of all births are done via C-sec­tion.

The Do­mini­can Repub­lic has the high­est rate of any na­tion, with 58.1 per­cent of all ba­bies de­liv­ered us­ing the pro­ce­dure. But in close to a quar­ter of na­tions sur­veyed, Csec­tion use is sig­nif­i­cantly lower than av­er­age. Au­thors pointed out that while the pro­ce­dure is gen­er­ally over-used in many mid­dle- and high-in­come set­tings, women in low­in­come sit­u­a­tions of­ten lack nec­es­sar­ily ac­cess to what can be a life-sav­ing pro­ce­dure. “We would not ex­pect such dif­fer­ences be­tween coun­tries, be­tween women by so­cioe­co­nomic sta­tus or be­tween prov­inces/states within coun­tries based on ob­stet­ric need,” Ties Bo­erma, pro­fes­sor of pub­lic health at the Univer­sity of Man­i­toba, Win­nipeg, and a lead au­thor on the study, said. Jane San­dall, pro­fes­sor of so­cial sci­ence and women’s health at King’s Col­lege Lon­don and a study au­thor, told AFP that there were a va­ri­ety of rea­sons women were in­creas­ingly opt­ing for surgery.

Le­gal con­cerns

These in­clude “a lack of mid­wives to pre­vent and de­tect prob­lems, loss of med­i­cal skills to con­fi­dently and com­pe­tently at­tend a vag­i­nal de­liv­ery, as well as medico-le­gal is­sues.” Doc­tors are of­ten tempted to or­ga­nize C-sec­tions to ease the flow of pa­tients through a ma­ter­nity clinic, and med­i­cal pro­fes­sion­als are gen­er­ally less vul­ner­a­ble to le­gal ac­tion if they choose an op­er­a­tion over a nat­u­ral birth.

San­dall also said there were of­ten “fi­nan­cial in­cen­tives for both doc­tor and hospi­tal” to per­form the pro­ce­dure. The study warned that in many set­tings young doc­tors were be­com­ing “ex­perts” in C-sec­tion while los­ing con­fi­dence in their abil­i­ties when it comes to nat­u­ral birth. It also iden­ti­fied an emerg­ing gap be­tween wealthy and poorer re­gions within the same coun­try. In China, C-sec­tion rates di­verged from 4 per­cent to 62 per­cent; in In­dia the range was 7-49 per­cent. While the US saw more than a quar­ter of all births per­formed by C-sec­tion, some states used the pro­ce­dure more than twice as of­ten as oth­ers. “It is clear that poor coun­tries have low C-sec­tion use be­cause ac­cess to ser­vices is a prob­lem,” said San­dall. “In many of those coun­tries, how­ever, richer women who live in ur­ban ar­eas, have ac­cess to pri­vate fa­cil­i­ties have much higher C-sec­tion use.”

In­cen­tives for both doc­tor and hospi­tal

Alarm­ing trend

C-sec­tions may be mar­keted by clin­ics as the “easy” way to give birth, but they are not without risks. Ma­ter­nal death and dis­abil­ity rates are higher af­ter C-sec­tion than vag­i­nal birth. The pro­ce­dure scars the womb, which can lead to bleed­ing, ec­topic preg­nan­cies (where the em­bryo is stuck in the ovaries), as well as still- and pre­ma­ture fu­ture births. The au­thors sug­gested bet­ter ed­u­ca­tion, more mid­wifery-led care and im­proved la­bor plan­ning as ways of en­sur­ing C-sec­tions are only per­formed when med­i­cally nec­es­sary, as well as en­sur­ing women prop­erly un­der­stand the risks in­volved with the pro­ce­dure. “C-sec­tion is a type of ma­jor surgery, which car­ries risks that re­quire care­ful con­sid­er­a­tion,” said San­dall. In a com­ment ac­com­pa­ny­ing the study, Ger­ard Visser of the Univer­sity Med­i­cal Cen­tre in the Nether­lands, called the rise in C-sec­tions “alarm­ing.” “The med­i­cal pro­fes­sion on its own can­not re­verse this trend,” he said. “Joint ac­tions are ur­gently needed to stop un­nec­es­sary C-sec­tions and en­able women and fam­i­lies to be con­fi­dent of re­ceiv­ing the most ap­pro­pri­ate care for their cir­cum­stances.”


CARA­CAS: In this file photo, doc­tors carry out a cae­sarean sec­tion in a ma­ter­nity cen­ter in Cara­cas.

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