Alarm bells rang for the public health community when the World Health Organisation (WHO) reported that the rate of caesarean section in China was an alarming 46.2% in 2010.

However, a new study from the collaboration between US and Chinese researchers in 2014 discovered that the rates were closer to 34.9%.

Caesarean sections made up 15% of births in the world in 2007

The number of C-sections has increased dramatically and continues to do so at a rate of 4.4% a year. Latin America and the Caribbean region lay claim to having the highest C-section rates, whilst Africa has the lowest rates of C-sections at 7.3%. Northern America (32.3%), Oceania (31.1%), Europe (25%) and Asia (19.2%) lie between these extremes.

The rates in Hong Kong have been growing fast in recent years as well – with an estimate of 27.1% in 2009, as compared to 19.5% in 2003.

Latest available data on caesarean section rates by country (not earlier than 2005). Image credit: PLoS One Journal/NCBI
Latest available data on caesarean section rates by country (not earlier than 2005). Image credit: PLoS One Journal/NCBI

C-sections associated with high maternal and perinatal risks

Excessive caesarean sections have been shown to impart unnecessary risks to both mother and child. Besides surgical complications, mothers are at an increased risk of postpartum thromboembolism, postpartum depression and have mortality rates that are four to 10 times higher.

Uterine scarring from caesarean sections also threatens women’s reproductive health. A caesarean scar leaves a woman 24 times more likely to develop an abnormally adherent placenta in her next birth.

The increasing preference for C-sections has been attributed to fear of pain, fear of genital changes, convenience of the health professionals and mother and the misconception that a C-section is safer for the baby. These findings have also been found to be applicable to the local population. Interestingly, women in Hong Kong who underwent in-vitro fertilisation were more likely to opt for an elective caesarean section.

Cultural factors also play a role. For example, couples in China would prefer to ‘schedule’ their baby’s birthday on the basis of date-specific luck. Hong Kong observed a similar scenario whereby mothers rushed to give birth in the Year of the Horse – thinking that ‘horse babies’ are more vigorous and healthier than ‘goat babies’.

Caesarean section should be carried out only when necessary

A caesarean section should only be recommended in the presence of clear indications such as maternal medical conditions; or in emergency situations of fetal distress. However, data shows that more and more obstetricians would carry out a caesarean section at the mother’s request in the absence of obstetrical indications – as high as 38% of Danish and 69% of UK obstetricians.

Advances in surgical and anaesthetic skills could be contributing towards this rise in preference towards caesarean sections. The increasing emphasis in patient participation in medical decisions could also be influencing the rates.

Nevertheless, a caesarean section has been proven to be a risky procedure. It is the responsibility of the attending physician to provide accurate counselling to the expectant mother, while always upholding the ethical principles of beneficence, non-maleficence and patient autonomy. MIMS

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