Doctors warn of global C-section 'epidemic'

C-section births rise rapidly to more than 20 percent worldwide

Caesareans now used in one in four UK births, major new report reveals

The US, Bangladesh, and Brazil reported C-section use in more than 25 per cent of births nationally, but some regions within these countries used C-section around twice as much as others.

But the procedure is unavailable to many women in low-income countries and overused in many middle- and high-income countries, the researchers found.

Common reasons why women request C-sections include past negative experiences of vaginal birth, fear of labor pain or of the effects of labor such as pelvic floor damage, incontinence and reduced sexual function. "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".

C-sections can save the lives of women and babies when there are birth complications such as fetal distress, or abnormal positioning.

It is estimated that the operation - a vital surgical procedure when complications occur during birth - is necessary 10-15 per cent of the time.

In 15 countries, more than 40% of births are by C-sections.

However, the researchers estimate that more than one in four countries in 2015 had lower levels (28 per cent), while most countries used C-section above the recommended level (63 per cent).

In France, the rate of caesarean section (20.4% in 2016) remains stable since 2010, "which suggests a general attitude tending to limit the achievement of this intervention", notes the latest perinatal survey published by the Ministry of Health.

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Looking at trends in Brazil and China where there is high use of C-section, the authors found that most C-sections were in low-risk pregnancies and in women who had previously had a C-section. "In Brazil, for example, the free public healthcare system is of poorer quality and pregnant mothers who can't afford private healthcare might be offered the procedure to help clear patients more quickly through the system".

"In cases where complications do occur, C-sections save lives, and we must increase accessibility in poorer regions, making C-sections universally available, but we should not overuse them", Temmerman said in a journal news release.

"In particular, C-sections have a more complicated recovery for the mother, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies".

Doctors say in many cases the use of the medical procedure is unjustified.

Emeritus Professor Gerard Visser, of University Medical Centre Utrecht in the Netherlands, and chairman of FIGO's Committee for Safe Motherhood and Newborn Health, said: "Worldwide there is an alarming increase in caesarean section rates".

'The medical profession on its own can not reverse this trend, ' he said. "Joint actions with governmental bodies, the health care insurance industry, and women's groups are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances".

"It is crucial that women who need Caesarean sections are able to access this potentially life-saving procedure", the World Health Organization advises, adding that it is equally important that unnecessary procedures be avoided "so women and their babies are not put at risk".

"What is left unresolved are the tensions generated when women's agency in choosing a caesarean section go against medical directives to intervene against them", says a Lancet editorial published along with the series. Obstetrician-gynecologists are already talking about the epidemic of caesarean section.

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