Caesarean section rates continue to rise worldwide and in some cases, these procedures are medically unnecessary and potentially harmful, a new study by the World Health Organization (WHO) has found.

According to the research, 21% of all births globally are via caesarean and this figure is expected to increase to 29% by 2030.

The study was based on nationally representative data from 154 countries from 1990 to 2018. While the worldwide rate of caesarean sections was 21% in 2018, this ranged from 5% in sub-Saharan Africa to 43% in Latin America and the Caribbean.

In five countries – Cyprus, Turkey, Egypt, the Dominican Republic and Brazil – caesarean sections now outnumber vaginal deliveries.

The WHO insisted that while a section can be an essential and life-saving surgery, it can put some women and babies at unnecessary risk of short and long-term health problems if there is no medical need for the procedure.

“Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed.

“But not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby,” commented Dr Ian Askew, director of the WHO’s Department of Sexual and Reproductive Health and Research.

The WHO pointed out that caesarean sections can be essential in situations such as prolonged or obstructed labour, foetal distress, or because the baby is presenting in an abnormal position.

However, as with all surgeries, this procedure can also carry risks. These include the potential for heavy bleeding or infection, slower recovery times after childbirth, delays in establishing breastfeeding and skin-to-skin contact, and increased likelihood of complications in future pregnancies.

The WHO also noted that the cause of high caesarean rates varies widely between and within countries. Drivers include health sector policies, health sector financing, the quality of healthcare and cultural norms.

It emphasised that rather than recommending specific target rates for caesarean sections, focus should instead be on each woman’s unique needs in pregnancy and childbirth.

“It’s important for all women to be able to talk to healthcare providers and be part of the decision making on their birth, receiving adequate information, including the risks and benefits. Emotional support is a critical aspect of quality care throughout pregnancy and childbirth,” noted Dr Ana Pilar Betran, a medical officer at the WHO.

The WHO has recommended some non-clinical actions that can reduce the rate of medically unnecessary caesarean sections. These include:

-Educational interventions that engage women actively in planning for their birth, such as childbirth preparation workshops and psychosocial support where desired. Implementation of such initiatives should include ongoing monitoring and evaluation

-The use of evidence-based clinical guidelines, performing regular audits of caesarean section practises in health facilities, and providing timely feedback to health professionals about the findings

-A requirement for a second medical opinion for a caesarean section decision in settings where this is possible.

The study, which is published in the journal, BMJ Global Health, can be viewed here.