Dramatic increase in Caesarean sections

WHO: For most women, giving birth is a pleasurable and exciting experience and, with great care and support, it is a safe procedure. However, improved technology and increased knowledge about childbirth have also brought a dramatic increase in the number of Caesarean sections (C/S). Medical interventions such as C/S, fetal monitoring and ultrasound are increasingly being used unnecessarily in some countries and women are pressurized into giving birth in a hospital when a home birth may be the best option.

Caesarean section on the rise

As C/S is become safer, the number of such operations has risen dramatically. In Turkey, for example, over 40% of all births are by C/S, exceeding the European Union average of 25.2%. C/S is deemed so safe that affluent women are being offered or choosing that method of giving birth instead of a vaginal delivery, which is normally the preferred choice. WHO has previously specified that a safe number of C/S is ideally 15%. There are many reasons for the startling increase, including:

• the rise in maternal obesity;
• a lack of access to doula support;
• breech presentation;
• C/S instead of forceps delivery;
• increased induction of labour;
• maternal preference (convenience, fear or avoidance of labour); and
• obstetrician preference (scheduling, income generation).

Although the incidence of maternal mortality and morbidity is approximately five times greater in C/S than vaginal births, there are some benefits.

• Approximately 10% of women have moderate to severe urinary stress incontinence following a vaginal delivery versus 5% of women who delivered by C/S.
• A C/S can be life-saving for a foetus in distress.
• A planned C/S allows the mother to schedule the delivery for convenience.
• There is no prolonged labour for the mother.

WHO response

The challenge for the WHO European Region is to give every mother the opportunity of a natural, safe birth and to involve her fully in the decision-making process. Gunta Lazdane, Programme Manager of the Sexual and reproductive health programme at WHO/Europe, recommends the following actions to promote a safe birth in the most recent edition of Entre Nous magazine, Birth in Europe in the 21st century:

• implement policies that are mother- and baby-friendly, such as home delivery with midwifery assistance (where appropriate);
• keep interventions to a minimum;
• promote breastfeeding;
• ensure clinical and practical guidelines embrace a life-course approach; and
• improve data for all indicators related to childbirth.

Ms Lazdane adds, "Without the appropriate data or analysis we are not able to fully comprehend the underlying issues to help improve and strengthen birth and birth experiences for everyone."
The latest edition of Entre Nous magazine, Birth in Europe in the 21st century, explores the increase in C/S, among other issues.