The Rise of Caesarean Sections: A Look at the Contributing Factors

 The Rise of Caesarean Sections: A Look at the Contributing Factors

  

A pie chart shows indications of category-1 emergency caesarean section in Gondar University specialized Hospital Northwest Ethiopia, 

Wide Variation in C-Section Rates Across India

The increasing rate of caesarean sections (C-sections) is a global phenomenon with significant implications for maternal and infant health. While the procedure can be life-saving in certain situations, its overuse raises concerns. This article explores the multifaceted reasons behind this trend, drawing on personal observations and insights.

Current guidance from the World Health Organization (WHO) considers 10%-15% to be the ideal c-section rate . C-section rates have doubled globally since 2000 and in many Low and Middle income Countries exceed the 10%-15% rate, introducing concern about overuse . Elective c-sections and other non-medically indicated c-sections carry an increased risk of infection, may necessitate c-section for future births, and reduce beneficial breastfeeding practices compared to vaginal delivery

1. The Impact of Modern Lifestyle:

 Sedentary Habits and Posture: The prevalence of sedentary lifestyles and the use of western toilets, eliminating the squatting position, contribute to the weakening of pelvic muscles and ligaments. This can make vaginal delivery more challenging.
 Lack of Physical Activity: A sedentary lifestyle can lead to reduced flexibility and overall physical fitness, potentially impacting a woman's ability to endure the labor process.
 
2. The Role of Family Dynamics:

 Nuclear Families and Lack of Experience: The rise of nuclear families often means a lack of experienced elders within the household who can provide guidance and support during pregnancy and childbirth. This can lead to a lack of awareness about the natural course of labor and the potential for vaginal delivery.
 Fear of Pain: The fear of the pain associated with vaginal delivery is often amplified in the absence of experienced family members who can offer reassurance and share their own experiences.

3. Patient Preferences and Medical Factors:

 Discomfort with Pelvic Examinations: Some women feel uncomfortable with pelvic examinations, leading to reluctance to undergo necessary assessments that could guide their birth plan.
 Patient Attendants' Impatience: The duration of labor, particularly for first-time mothers (primiparas), can be long (14-16 hours or more). In some cases, patient attendants lack the patience to wait for a natural vaginal delivery, leading to requests for C-sections.
 Career Concerns: For women with demanding careers, the potential disruption of a prolonged labor or complications during vaginal delivery can be a significant concern. This can lead to a preference for a planned C-section, perceived as more predictable.

4. Medical Professional Influence:

 Doctor's Preference: C-sections offer a degree of control and predictability for doctors. Some doctors may be more inclined to recommend C-sections, particularly in situations where a vaginal delivery might require more time and effort.
 Availability of Anesthetists: The availability of anesthetists can be a factor, particularly during nighttime and off-hours. The lack of readily available anesthetists can lead to a decision for C-section even in cases where vaginal delivery might have been possible.
 Paediatrician Charges: The cost of neonatal intensive care (NICU) for babies with complications can be significantly higher than the cost of a C-section. This financial burden can lead to pressure on doctors to recommend C-sections, even if the risk of complications for the baby is minimal.

5. Patient Misconceptions and Misinformation:

 C-section Safety: The perception that C-sections are safer than vaginal delivery, fueled by the availability of powerful pain medications, can lead to patients opting for the procedure without fully understanding the potential risks and complications.
 Fear of Forceps: The fear of forceps marks and the lack of experience with forceps among some doctors can contribute to a preference for C-sections.
 Baby's Well-being: There is a misunderstanding that a vaginal delivery can harm the baby. While it's true that there can be risks, the natural process of labor and delivery is designed to benefit both mother and child.

6. The Importance of Informed Decision-Making:

It is crucial for women to be aware of the potential risks and benefits of both vaginal delivery and C-sections. They should be empowered to make informed decisions based on their individual circumstances and preferences. Open communication with their healthcare providers is vital to ensure their birthing experience aligns with their goals and values.

7. Government Initiatives and Education:

While government initiatives encourage normal deliveries, there needs to be a stronger focus on educating both patients and healthcare providers about the benefits of vaginal delivery and the potential risks of unnecessary C-sections.

8. The Future of Childbirth:

The rising rate of C-sections is a complex issue with no easy solutions. It requires a collaborative effort involving patients, healthcare providers, and policymakers to address the underlying factors contributing to this trend. By promoting informed decision-making, advocating for natural childbirth, and addressing the concerns of both patients and doctors, we can strive for a more balanced approach to childbirth that prioritizes the well-being of both mothers and babies.