Caesarean section use has almost doubled globally since 2000

Globally, the number of babies born through caesarean section (C-section) almost doubled between 2000 and 2015 – from 12% to 21% of all births – according to a Series of three papers published in The Lancet.

The Series reviews disparities in C-section use around the world, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary C-sections.

C-section is a life-saving intervention for women and newborns when complications occur, such as bleeding, foetal distress, hypertensive disease, and babies in abnormal position. But, the surgery is not without risk for mother and child, and is associated with complications in future births.

Professor Jane Sandall, the CLAHRC’s maternity and women’s health theme lead, is the lead author on one of the papers, which examines the short and long-term effects of caesarean section on the health of women and children.

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

The Series authors estimate that more than one in four countries in 2015 had lower levels (28%, 47/169 countries), while most countries used C-section above the recommended level (63%, 106/169 countries). In the UK, C-section use has increased from 19.7% of births in 2000 to 26.2% in 2015, slightly below the Western European average. In at least 15 countries C-section use exceeds 40%.

As well as highlighting these disparities in global C-section use, the series examines the harms associated with C-section overuse and underuse.

C-section improves maternal, newborn and child survival when complications arise, and can lower the risk of incontinence and prolapse. However, maternal death and disability is higher after C-section than vaginal birth. In particular, C-sections have a more complicated recovery for the mother, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies.

The authors emphasise that these are small but serious risks and depend on where in the world the operation is taking place, but each of these risks increases as a woman has more C-sections.

There is emerging evidence that babies born via C-section have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health. While the long-term risks of this are not well-researched, the short-term effects include changes in immune development which can increase the risk of allergies and asthma and alter the bacteria in the gut.

Professor Jane Sandall says: “Greater understanding of this is important to help inform decision making by families, health care staff, and policy makers. It’s important to listen to women, respecting autonomy and choice, ensuring quality of care where women have privacy, are treated with dignity and have companions of choice with them.”