In 1985 The World Health Organization (WHO), issued a report of concern based on their assessment that the 10% to 15% rate of Cesarean sections compared to natural birth had far exceeded that number, which was considered ideal.
The increasing rate of Cesarean section (C-section) deliveries in America, had reached an alarming 32.1%, seemingly evidently due to pregnant women opting for this method. The concern from WHO is due to the associated health risks. Any one of a number of factors including medical, cultural, and personal reasons contributes to this trend.
One significant factor is the “medicalization” of childbirth which has always been and should continue to be a natural process. However advances in medical technology have made C-sections more accessible and possibly due to fear of pain in the birthing process, there has been an increased reliance on this method by healthcare providers and patients alike and this is expected to continue to rise. To make matters worse, consider the fact that 4 out of 5 of these women are expected to have another cesarean section delivery for subsequent births.
On June 16th 2021, WHO again published an article citing further concerns that rising rates suggest an increasing number of medically unnecessary, potentially harmful procedures! The article further stated that, while C-sections can be essential to life saving surgery, it can put women and babies at unnecessary risk of short or long term health problems if performed when there is no medical need to.
But America is not the worst. In the Dominican Republic, Brazil, Cyprus, Egypt and Turkey, C-sections out number normal vaginal deliveries.
Doctors may opt for C-sections to avoid potential complications such as fetal distress, prolonged labor, or failure to progress during vaginal delivery. Additionally, the fear of medical litigation can influence healthcare providers to choose C-sections as a precautionary measure to reduce potential legal liabilities. WHO suggests that quality women centered care is needed to address the high use of C-sections.
Dr. Ana Pilar Betran, Medical Officer at WHO and HRP cautions that it is important for all women to be able to talk to their healthcare provider and be part of the decision making process on their baby’s birth, ensuring that they receive adequate information including the risks, and benefits, where necessary.
But cultural and societal influences also play a role in the rising C-section rates. Western societies often prioritize control and convenience, and C-sections can be perceived as more predictable and scheduled compared to natural childbirth. Social expectations, influenced by media depictions and personal anecdotes, may create the perception that C-sections are a safer or more desirable option. This cultural influence can lead women to request or consider C-sections without fully understanding the associated risks.
Personal reasons also contribute to the high C-section rates. Some women may have specific preferences or concerns that lead them to choose this method. As stated before, fear of pain during vaginal birth, anxiety about the unknown, or previous traumatic birth experiences can all influence a woman’s decision. Some women may also have a perceived need for C-sections due to concerns about their body image, the impact of childbirth on their sexual function, or their ability to regain pre-pregnancy physical appearance.
Socioeconomic factors also come into play. Women with higher levels of education and income may be more likely to opt for C-sections. They may have greater access to private healthcare facilities or be influenced by a desire to maintain control over their birth experience.
Conversely, women from disadvantaged backgrounds may have limited access to information, prenatal care, and healthcare providers who, for reasons better known to them, do not promote natural childbirth. As a result they are left with no option but to opt for the same. This lack of resources and information can however, contribute to a higher rate of C-sections among marginalized populations.
It is important to note that not all C-sections are unnecessary or without medical indication. Some pregnancies carry higher risks, such as multiple pregnancies, breech presentations, or maternal health conditions, where C-sections may be the safest option but this does not mitigate the concerns arising, when C-section rates exceed the recommended threshold set by the WHO, which remains around 10-15%. Beyond this threshold, the health risks associated with C-sections, such as increased maternal morbidity, longer recovery times, potential complications in subsequent pregnancies, and limited availability of this procedure in resource-constrained settings, becomes even more significant.
Addressing the rising C-section rates requires a multifaceted approach. Emotional support is a critical aspect of quality care throughout pregnancy and childbirth. Educating women and healthcare providers about the risks and benefits of different delivery methods is crucial. Encouraging shared decision-making between women and their healthcare providers can help ensure that choices are based on accurate information and individual circumstances. Improving access to quality prenatal care and support for natural childbirth can also empower women to make informed decisions and reduce the need for unnecessary C-sections.
Addressing this issue requires a comprehensive approach that involves education, shared decision-making, and improved access to prenatal care, aiming to promote safe and healthy childbirth practices.