• Profile
Close

Is the C-section Birth Rate Higher Than It Should Be?

M3 India Newsdesk Apr 06, 2017

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
Only Doctors with an M3 India account can read this article. Sign up for free.
  • 55 lakhs+ doctors trust M3 globally

  • Nonloggedininfinity icon
    Unlimited access to original articles by experts
  • Nonloggedinlock icon
    Secure: we never sell your data
  • Signing up takes less than 2 mins
Try M3 India / Log In
x
M3 app logo
Choose easy access to M3 India from your mobile!


M3 instruc arrow
Add M3 India to your Home screen
Tap  Chrome menu  and select "Add to Home screen" to pin the M3 India App to your Home screen
Okay