Sunday February 17, 2019

C-Section Births Doubles In Number, Reaching Epidemic Proportions: Doctors

C-section is a type of major surgery, which carries risks that require careful consideration

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A newborn, one of 12 babies born by C-section, cries inside an incubator at the Bunda Hospital in Jakarta, Indonesia, Dec. 12, 2012. VOA

Worldwide cesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.

They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine.”

In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide, or 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet.

It is estimated that the operation, a vital surgical procedure when complications occur during birth, is necessary 10-15 percent of the time.

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The Yusuf Dantsoho Memorial Hospital has a high success rate with C-sections. Kaduna, Nigeria. Photo by Chika Oduah, VOA

Varying country rates

But the research found wildly varying country rates of C-section use, often according to economic status: In at least 15 countries, more than 40 percent births are performed using the practice, often on wealthier women in private facilities.

In Brazil, Egypt and Turkey, more than half of all births are done via C-section.

The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure.

But in close to a quarter of nations surveyed, C-section use is significantly lower than average.

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Maternal death and disability rates are higher after C-section Flickr

Reasons to opt for surgery

Authors pointed out that while the procedure is generally overused in many middle- and high-income settings, women in low-income situations often lack necessary access to what can be a life-saving procedure.

“We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.

Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.

These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.”

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It also identified an emerging gap between wealthy and poorer regions within the same country. Flickr

Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.

Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.

The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth.

Income a factor

It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.

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Worldwide, more than 11 percent of babies are born premature. Pixabay

While the U.S. saw more than a quarter of all births performed by C-section, some states used the procedure more than twice as often as others.

“It is clear that poor countries have low C-section use because access to services is a problem,” Sandall said. “In many of those countries, however, richer women who live in urban areas, have access to private facilities have much higher C-section use.”

Risks to mother, child

C-sections may be marketed by clinics as the “easy” way to give birth, but they are not without risks.

Maternal death and disability rates are higher after C-section than vaginal birth. The procedure scars the womb, which can lead to bleeding, ectopic pregnancies (where the embryo is stuck in the ovaries), as well as still- and premature future births.

 

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Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic. Flickr

 

The authors suggested better education, more midwifery-led care and improved labor planning as ways of ensuring C-sections are only performed when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.

“C-section is a type of major surgery, which carries risks that require careful consideration,” Sandall said.

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

“The medical profession on its own cannot reverse this trend,” he said. “Joint actions are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate care for their circumstances.”

Next Story

Study Claims, There Should Be Treatment Options Given for Miscarriage

Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. 

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Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. Pixabay

Though miscarriage is a traumatic experience for both parents, resulting in feelings of loss and grief that in some cases can lead to anxiety and depression, women experiencing miscarriage should be offered a choice in the treatment they receive, suggests a study.

Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies.

Although guidelines recommend trying to resolve an unsuccessful pregnancy naturally, the new analysis shows that this is only successful in 70 per cent of cases, and potentially comes with complications that are rarely communicated to patients.

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Some women are more keen on having a quick surgical intervention so that they can resume their lifestyle immediately, some are very keen to avoid surgery and prefer to go with a tablet, and others want to take a more natural approach,” Wattar added. Pixabay

The study from the University of Warwick and Queen Mary University of London, demonstrates little to no difference in medical effectiveness in resolving an unsuccessful pregnancy between medical and surgical options.

Thus, the team recommend the doctors to offer women a choice of treatment options for miscarriage to enable them to make an informed decision that takes account of potential uncomfortable side effects, long waiting times and extended periods of recovery.

“What we have to do is provide women with evidence about the benefits and effectiveness of each treatment option and potential side effects so that they can choose what they feel most comfortable with,” said lead author Bassel Wattar from Warwick Medical School.

“Some women are more keen on having a quick surgical intervention so that they can resume their lifestyle immediately, some are very keen to avoid surgery and prefer to go with a tablet, and others want to take a more natural approach,” Wattar added.

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Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. Pixabay

For the results, published in the journal Human Reproduction Update, the team reviewed 46 trials involving over 9,000 women who experienced spontaneous loss of pregnancy (miscarriage) before 14 weeks gestation.
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During a miscarriage, the body will aim to resolve the unsuccessful pregnancy naturally but conservative treatment can be painful with increased bleeding, increased likelihood of hospital admission, reduced quality of treatment and reduced satisfaction.

However, surgery which include electric vacuum aspiration, and medical treatment with a tablet were found to have similar effectiveness in treating miscarriage as conservative treatment. (IANS)