Sunday November 18, 2018

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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c-section, postpartum depression
A newborn, one of 12 babies born by C-section, cries inside an incubator at the Bunda Hospital in Jakarta, Indonesia, Dec. 12, 2012. Several hospitals in Indonesia's main cities performed more cesareans than usual with new mothers hoping a 12-12-12 birth date will bring luck to their newborns. VOA
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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.

Also Read: Novel Blood Test May Predict Autism Risk In Babies During Pregnancy

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.”

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Lack of Proper Sanitation Affects 620 Million Children Around The World: Report

Despite the improvements, more than a third of the girls in South Asia miss school for one to three days a month during their period.

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A new toilet recently installed in a Rohingya refugee camp in Bangladesh. VOA

A lack of proper school toilets threatens the health, education and safety of at least 620 million children around the world, the charity WaterAid said in a new study published Friday.

Children at 1 in 3 schools lack access to proper toilets, putting them at risk of diarrhea and other infections and forcing some to miss lessons altogether, according to the study, based on data from 101 countries.

Guinea-Bissau in West Africa has the worst school toilets while Ethiopian children fare worst at home, with 93 percent of homes lacking a decent toilet according to the report, released ahead of World Toilet Day on Monday.

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Students arrive for class at the Every Nation Academy private school in the city of Makeni in Sierra Leone, April 20, 2012. VOA

“The message here is that water and sanitation affect everything,” WaterAid spokeswoman Anna France-Williams told the Thomson Reuters Foundation. “If there’s no toilet in schools, children will miss lessons and it will have an impact on their growing up.”

Diarrhea, infection risk

A lack of proper sanitation puts millions of children around the world in danger of diarrhea, which kills 289,000 children younger than 5 a year, WaterAid said.

But some regions have started to clean up their act, notably South Asia, where access to toilets in schools has improved.

More than half the schools in Bangladesh now have access to decent toilets, while students in 73 percent of schools in India and 76 percent of those in Bhutan can access basic sanitation.

Akramul Islam, director of water, sanitation and hygiene at the Bangladeshi charity BRAC, said the country’s once-high levels of open defecation — using open ground rather than toilets — were now less than 1 percent.

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India’s plight in sanitation has not improved much since ages.
Pixabay

“Today, schools have separate toilets for girls and boys and the issue of menstrual hygiene is also being addressed,” he said. “This has happened because of initiatives taken by both the government, the NGOs and other stakeholders.”

Also Read: 3 HIV+ Students Banned From School in Indonesia

Improvement needed

Despite the improvements, more than a third of the girls in South Asia miss school for one to three days a month during their period, WaterAid said, urging greater investment in basic sanitation.

“If we are serious about all children and young people, wherever they are, whatever their gender, physical ability or community background, having their right to clean water and sanitation, we must take decisive and inclusive action now,” said Chief Executive Tim Wainwright. (VOA)