Scientists raise concerns over global spike in C-sections

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In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide - 21 per cent of all births.

The study has already prompted responses from countries, with the Minister of Health of Brazil Gilberto Magalhães Occhi releasing a new country-wide strategy alongside the study to try and reduce the use of C-sections and ensure quality maternal health care.

But the procedure can lead to scarring of the womb, which heightens the risk of complications during future births, such as from bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth.

"Pregnancy and labour are normal processes, which occur safely in most cases", explains lead author of the series Marleen Temmerman, a gynaecologist and professor at Aga Khan University, Kenya and Ghent University, Belgium.

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

Cesarean delivery, a surgical procedure in which a baby is born via incisions in the uterus and abdomen, now accounts for 21 percent of all births around the world, according to the new findings, compared to just 12 percent 18 years ago.

In a series of three papers, the researchers tracked trends in C-section use globally and in nine regions based on data from 169 countries from World Health Organization and Unicef databases.

While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure tends to be overused in many middle- and high-income settings, they said.

Globally, the number of babies born through caesarean section (C-section) nearly doubled between 2000 and 2015 - from 12% to 21% of all births.

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"In cases where complications occur, cesarean section births save lives, and we must promote women's access [to C-sections] in poor areas, but we should not abuse them".

Experts estimate that between 10 and 15 percent of births medically require a C-section due to complications such as bleeding, foetal distress, hypertension or a baby being in an abnormal position.

C-sections were also overused in the North America, Western Europe, Latin America and the Caribbean, where rates rose about 2 percent a year over the study period of 2000 to 2015. In places such as Brazil and China, numerous c-sections performed were in women with low-risk pregnancies, in women who previously had c-sections, and in women who were well-educated.

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.

In a comment accompanying the study, Gerard Visser of the University Medical Centre in the Netherlands, called the rise in C-sections 'alarming'.

As such, the researchers note how important it is for women to understand the serious risks of getting c-sections and why it is important to opt for it only when necessary.

"Although The Lancet Series says that women's demand is not a substantial driver of the current problem of overuse, efforts to reduce caesareans must, nevertheless, strongly respect women's rights to choose the circumstances of birth".

"Pregnant mothers must have access to professional and informed advice in order to make a decision". Annually in France, cesarean section is 20% if delivery.

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