CS rates upto 80-90% are reported in certain areas. What are the contributing factors in developed and developing world? Should we regulate the practice? There is a changing trend nowadays with rising incidences of lower segment cesarian sections. What is the effect of this on women's health? Should we do so something to reduce the rising rate?
The complications and the cost burden in the health care system is huge.
I do remember that I have come across a study 30 years ago which reported that Cesarean section rate is higher in countries with paid surgical activities and low in countries with social solidarity health systems. Now CS is high because of the big share of private practice and to some extent women choice.
One of the solution can be the initiatives of counseling the Doctors. Because many Cesarean sections conducted especially in the developing countries are proved unnecessary and happened only for Doctors' interest.
In our center Total 497 deliveries occurred in the six months study period, among them 64.4% normal vaginal delivery, 34.4% were cesarean.
Among 171 cesarean sections, 111(64.9% ) were emergency cesarean with rest (35.1%) were elective cesarean sections. (Data Unpublished)
Though the findings suggest high CS rate than the WHO target CS rate in developing nations,
In our center Cesarean section is performed if there is high risk factors needing cesarean section for the benefit of both mother and fetus, or failed induction or fetal distress detected by cardiotochography. so, in our center in my personal opinion from observation, early detection of alteration of fetal biophysical profiles by new modalities and techniques and judging risk benefit of continuing pregnancy from the international guidelines leads to decision of CS (perhaps little higher rate).
To address the problem I think we should counsel and discourage demand CS. Also in private practice should not be encouraged for beneficence of practitioner than the absolute indications.
God delivers vaginally, doctors deliver abdominally.
Impact on maternal health
Incidence of placenta previa with accreta will be increased. Further cost and involvement of other specialists like radiologists, urologists will be increased. Management of those cases is not easy and not for every one. Failure to manage those case could put one in legal problems.
This is a globally recognised problem and has multiple contributing factors, varying from region to region. In Palestine the caesarean seciton rate if around 23% but also rising, although in general women are unwilling to undergo CS and maternal request is not common here and also not a recognised indication.
However, differences exist between hospitals, which are not due to obstetric or sociodemographic features, but have other reasons. This might be the way to make a diagnosis such as fetal distress or management of poor progress during labour. But generally, a lack of unified and agreed upon guidelines might be driving this difference and the general trend of increasing caesarean section rates.
Therefore, development of guidelines and promotion of guideline adherence might be the one way to curve the trend of increasing CS rates.
Yes CS rates have increased unreasonably in the past few decades. without going in to reasons and blaming obstetricians for being impatient and women asking for a CS instead of vaginal birth, I would like to suggest how we can reduce CS rate that we all feel concerned about. We need to give the power of giving birth naturally back to the women. Some of them have forgotten this power that nature has given them. It must start early from adolescent period, before marriage, then soon after marriage when they start planning to have a child. Each women coming for the ANC checkup should be seen by the midwife and given necessary help and information. We do it in our Healthy Mother, Healthy Baby clinic. This clinic started in 2012 with the aim to empower women and Midwifery. We started Natural birthing center run by midwives in 2016 with great results and appreciation by the mothers. We named this birthing center "SWA" in Hindi meaning the power of a women. Those interested can communicate directly with SWA team.
Midwifery needs to be strengthened . Its the midwife who will empower the women to realize her power to deliver Vaginally.
We must encourage low risk labour rooms managed by Midwives, where natural child birth is encouraged with back up facility for high risk care under the obstetrician ,if needed .
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