How do you interpret the rising rate of caesarean section in the world? Is it due to patient factors or medical reasons?
It is known that the rate of caesarean deliveries are rising globally. Many factors are contributing to its increase. It is partly by the influence of patients themselves opting for surgery, while others may be driven by medically indicated or un-indicated reasons.
18 Answers
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IB
1. Lack of prenatal care in rural areas, leads to late identification of complications in pregnancy and therefore increas of C sections.
2. Increase in teenage pregnancies in Sub Sahara Africa, see increased Cephalopelvic disproportion.
3. Beter fertility treatment leads to more precious babies and preferred C sections.
4. Increase in older primigravida, where doctors often prefer C sections.
5. High anxiety towards normal delivery and lack of control cause more elective C sections.
6. Do not underestimate genetics, as women deliver babies through C sections that would not have survived in previous years and therfore increase in Cephalopelvic disproportion genes surviving.
2. Increase in teenage pregnancies in Sub Sahara Africa, see increased Cephalopelvic disproportion.
3. Beter fertility treatment leads to more precious babies and preferred C sections.
4. Increase in older primigravida, where doctors often prefer C sections.
5. High anxiety towards normal delivery and lack of control cause more elective C sections.
6. Do not underestimate genetics, as women deliver babies through C sections that would not have survived in previous years and therfore increase in Cephalopelvic disproportion genes surviving.
Haitham Jowah
As a surgeon in Yemen, I observe this worldwide trend through a very distinct and difficult local lens. The increasing number of C-sections here is not just a matter of patient choice vs medical necessity; it is a complicated web made up of our own healthcare reality.
In my experience, patients do ask for elective C-sections, but they are not the main reason for them. The rise is more deeply entrenched in problems with the system:
1- A Primary Healthcare System That Is Weak: A lot of women, especially those who live in rural regions, may not get enough or consistent prenatal care. They commonly come to the hospital late in labor when problems like prolonged labor, fetal distress, or pre-eclampsia are already well-known. At that time, a C-section is no longer an option; it is an emergency need to preserve two lives.
2- The "Precious Baby" Factor: For families who have had trouble getting pregnant or have lost children in the past, this pregnancy is very special after years of fighting and pain. There is a lot of pressure, both from the family and occasionally from the doctor, to make sure the baby is born alive. People often think that a scheduled C-section is the most controlled and "safest" way to go, even though it skips the unknowns of labor.
3- Not enough resources to help with vaginal birth: To safely handle a high-risk vaginal birth or a trial of labor after a cesarean (TOLAC), you need to keep an eye on the fetus at all times, have skilled midwives on duty, and have an operating room ready to go right away. In a lot of our hospitals, these resources are running low. The clinician may feel safer choosing a scheduled C-section than risking a bad outcome during a poorly monitored, high-risk labor.
So, even if medical reasons are virtually always the official reason, the truth is that our system's flaws often cause those reasons. It is not so much about what the patient wants as it is about the whole system moving toward what is thought to be the safest path in a very high-risk situation.
In my experience, patients do ask for elective C-sections, but they are not the main reason for them. The rise is more deeply entrenched in problems with the system:
1- A Primary Healthcare System That Is Weak: A lot of women, especially those who live in rural regions, may not get enough or consistent prenatal care. They commonly come to the hospital late in labor when problems like prolonged labor, fetal distress, or pre-eclampsia are already well-known. At that time, a C-section is no longer an option; it is an emergency need to preserve two lives.
2- The "Precious Baby" Factor: For families who have had trouble getting pregnant or have lost children in the past, this pregnancy is very special after years of fighting and pain. There is a lot of pressure, both from the family and occasionally from the doctor, to make sure the baby is born alive. People often think that a scheduled C-section is the most controlled and "safest" way to go, even though it skips the unknowns of labor.
3- Not enough resources to help with vaginal birth: To safely handle a high-risk vaginal birth or a trial of labor after a cesarean (TOLAC), you need to keep an eye on the fetus at all times, have skilled midwives on duty, and have an operating room ready to go right away. In a lot of our hospitals, these resources are running low. The clinician may feel safer choosing a scheduled C-section than risking a bad outcome during a poorly monitored, high-risk labor.
So, even if medical reasons are virtually always the official reason, the truth is that our system's flaws often cause those reasons. It is not so much about what the patient wants as it is about the whole system moving toward what is thought to be the safest path in a very high-risk situation.
Mekonen Kebede
Reasons vary from nation to nation. In developed world the main reason for C/S was fear of labour pain. Where as medical complication were the main reasons for C/S in developing nations.
Khazew
There are many factors which made the women to Do caesarean section firstly to Decreasing the pain of labour.
PharmCath
Along with other factors others have mentioned, increased global rates of gestational diabetes increases pregnancy related complications (e.g. shoulder dystocia, macrosomia, eclampsia) which can all increase the risk/need for a C-section - either elective or emergency.
Ramadhani
It is both biological, social, and individual factors; CS gives women the power to decide when to deliver. Advanced medicine has made CS less risky, some previous bad experiences with normal delivery could be a factor. In some societies, family chooses certain dates/days for their believe which makes it easier for CS than normal delivery.
Dr Mac
I had a hysterotomy and three hysterectomies. As I am a veterinarian who has done a LOT of caesarian sections on companion animals and production animals I was VERY dissatisfied. My opinion is that there are too many obstetric cases in the hospitals and staff opt for surgery because it takes less time than monitoring a birth AND the profit is a great deal higher. The excuse I heard was that surgery is better for the baby. Well I have several female colleagues in Academia who gave birth naturally to VERY intelligent children. Women need to join a society of sorts in their area and help raise funds for clinics where you can go if you are in labour; there will be midwives available and they can refer for surgery if needed.
Daniel N. Munywoki
Some hospitals encourage CS due to the monetary gains raked in from insurance companies. In other cases, it is the patients requesting because of fear of birth or labour pains.
Ovidiu Tatar
Unless we have clear data that the incidence of medical indications has risen, most probably the increase in the number of caesarean deliveries is driven by patient preferences .
Federico Benetti MD
Several factors vary in each country and also within it. Apart from the woman's desire for factors of all kinds, from medical condition to cultural and medical-legal, there are factors of economic convenience of both parties that play a fundamental role in the cesarean section intervention.
Goran Augustin
The answer is very easy. Two reasons.
1. Some women do not want to 1) feel labor pains, 2) have any problems, including episiotomy resulting in sexual dysfunction, with their body image, which can result in vaginal delivery, and 3) eliminate any fetal issues with complications of vaginal delivery.
2. Older women with more comorbidities (D mellitus, obesity, etc) get pregnant. Also, many (older) women need assisted reproductive technologies to get pregnant. All these factors increase obstetric complications, and elective or emergent C-section is the only option. In a tertiary referral centre in Zagreb, Croatia, the C-section rate is currently 40%, and 10 years ago, it was 26%. All pathologic pregnancies come to that centre.
1. Some women do not want to 1) feel labor pains, 2) have any problems, including episiotomy resulting in sexual dysfunction, with their body image, which can result in vaginal delivery, and 3) eliminate any fetal issues with complications of vaginal delivery.
2. Older women with more comorbidities (D mellitus, obesity, etc) get pregnant. Also, many (older) women need assisted reproductive technologies to get pregnant. All these factors increase obstetric complications, and elective or emergent C-section is the only option. In a tertiary referral centre in Zagreb, Croatia, the C-section rate is currently 40%, and 10 years ago, it was 26%. All pathologic pregnancies come to that centre.
Marema
I think both factors have contributed to cesarean section. The increased early diagnosis of pregnancy conditions has increased the rate of CS. as well the availability of CS increased personal choice.
Maria Marta Facchinetti
It is due to both the individual election to avoid normal pain, and to medical reasons (i.e. nowadays a higher proportion of women choose to have babies later in their lives and therefore, higher risks for the labour work is more frequent)
Ariana
1. Some women do not want to 1) feel labor pain, 2) have medical problems, 3) Older women with more comorbidities get pregnant. 4) "precious child" out of assisted reproduction pressure.
2. OBGYNs get less training and less practice on the complications of natural delivery hence they are scared to perfom. The number of midwives practicing is shrinking by the day and there are not enough schools of midwives available.