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15 October 2018, 05:53 | Melissa Porter
Surgery in progress. /COURTESY
Based on data from the World Health Organization (WHO) and UNICEF, researchers found that the global use of c-section increased by 3.7 percent per year, with North America, Latin America, the Caribbean, and Western Europe overusing the procedure. That translates to 16 million of the 132 million live births in 2000 and 30 million of the 141 million live births in 2015. They said that while 10-15% of live births require C-section, most countries exceed this level.
This trend seems to be driven, at least in part, by higher-income women and those in urban areas, who may elect for C-sections because they fear labor pain, sexual dysfunction or incontinence related to vaginal birth, the authors write.
In Brazil, Egypt and Turkey, more than half of all births are done via C-section.
The nation with the highest rate for using the surgery to assist childbirth is the Dominican Republic with 58.1%.
But in close to a quarter of nations surveyed, caesarean section 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 low-income situations often lack necessarily access to what can be a life-saving procedure.
In the article, the World Congress of Gynecology and Obstetrics in Brazil puts forward several hypotheses as to the reasons for this "epidemic", including a decline in the competence of the medical profession to accompany a potentially hard childbirth by natural means, the comfort of scheduling day births, and more attractive rates for doctors and clinics in case of caesarean section.
Dr Jane Sandall, professor of social science and women's health at King's College London and a study author, said there were a variety of reasons for women increasingly opting for surgery.
"Globally, drivers for the increasing rates vary between countries and include a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a [potentially difficult] vaginal delivery, as well as medico-legal issues".
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But experts also warn that the increase in C-sections needs to come alongside a greater awareness of the health risks that accompany the procedure.
It also identified an emerging gap between wealthy and poorer regions within the same country.
While the U.S. saw more than a quarter of all births performed by C-section, some states used the procedure more than twice as often as others.
"In cases where complications do occur, c-sections save lives, and we must increase accessibility in poorer regions, making c-sections universally available", says Temmerman, "but we should not overuse them".
C-section is a type of major surgery, which carries risks that require careful consideration.
Nearly 30 million C-sections were performed globally in 2015, accounting for 21% of all live births, according to World Health Organization and UNICEF data published Thursday in the Lancet.
The procedure scars the womb, which can lead to bleeding, ectopic pregnancies, as well as stillbirths and premature future births. The procedure is 1.6 times more likely to take place in a private institution rather than a public one, perhaps due to persistent shortages of staff and facilities in rural and vulnerable regions.
It has also become "fashionable" and considered "modern" or safer to have a C-section in some countries, the research said.
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 can not reverse this trend".
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