Why are cesarean sections on the rise?
I write this BLOG from St. Petersburg and have a colleague from Athens who mentions that the overall C-section rate is 50% due to cesarean on demand by women.
As promised last week here I am penning for you the reasons for the rising cesarean sections rates.
Let us understand what is the standard rate what does it mean and what’s actually happening?
Cesarean section rate is the number of cesarean sections performed out of 100 vaginal deliveries. The accepted incidence globally and endorsed by the World Health Organization is 15 to 17 percent while it is seen to vary remarkably all across the world . Especially in the last decade there is a sharp rise in cesarean sections and various reasons seem to be apparent
Facilities which cater to high-risk pregnancies which are usually referred for special care or high dependency care have a higher incidence of cesarean deliveries. Various factors have been identified to be responsible for the same. Increase access to diagnostics such as Sonography, Color Doppler studies, electronic fetal monitoring, close antenatal ( during pregnancy )as intranatal surveillance ( during delivery ) help identify abnormalities earlier and therefore put both the doctor and the patient on guard. Increase age of the mother at conception is an important contributor to increasing associated abnormalities such as obesity, raised blood pressure, diabetes and many other underlying disorders. Audits in countries such as Abudhabi have revealed that lack of mobility and physical activity in mothers and increasing central obesity is associated with the rise in cesarean deliveries. In our country, we find that fetal distress ( which means baby’s health is at risk identified by slowed down heart rates, Baby passing stools while delivering called as meconeum stained liquor ) is identified to be the commonest cause.
Many times these babies are either growth restricted due to various reasons such as anemia in mother or raised blood pressure in mother or dietary deficiencies or have some compromised health due to excess growth as seen associated with Diabetes in the mother, obesity in the mother. Typically overweight babies and mothers both can have difficulties while delivering and have increased possibility of a cesarean delivery. In countries like the USA fear of litigations have reduced the threshold to a vaginal delivery. In addition, there are many mothers who have something called as ‘ tocophobia ‘ which means a fear of delivery pain.
How can one reduce cesarean deliveries is an important question ?
Many things can be done
Controlled weight gain during pregnancy and proper nutritional and overall care to ensure a healthy baby can help in reducing cesarean deliveries by reducing the complications of pregnancy
Reducing apprehension, increasing physical activity, positive approach and mine modulation therapies to overcome fear of pain can help
Reducing the primary cesarean section rates in Women who are delivering for the first time.This can be possible again by observing the first 2 points mentioned
Open discussion between the patient and the doctor to understand issues and participate in the delivery as a team can go a long way in achieving an optimum result
As always illustrations
Mrs S a mother who was exposed to many medications for a serious brain infection inadvertently during pregnancy was unaware that she was pregnant. After confirming a healthy pregnancy at 26 weeks we continued care throughout her prenatal period. With huge concerns due to her underlying ailments which involved serious brain-related complications due to infections, she was very positive in her approach and extremely cooperative .at about 38 weeks she reported with water break and had to be delivered .with close monitoring, patience she delivered a healthy 2.8 kg baby girl who was healthy. This was possible due to her extreme trust in whatever we decided for her
Mrs A had come down from bangalore at 29 weeks . Had mild rise in blood pressure and had a prepregnacy BMI of 33 which categorised her as obese . She had put on already 11 kgs by now as against her recommended allowed weight gain of 7to 9 kg for the entire pregnancy.she was very keen on a vaginal delivery but did not attend the prenatal exercise and dietary advices . At 34 weeks she developed increased blood pressure and refused admission which was advised to monitor her blood pressure . She opted to take medicines at home . At 35 weeks she reported with severe swelling all over the body and was diagnosed as Preclampsia which is a raised blood pressure disorder of pregnancy which can cause grave risks to the mother and the Baby.She was advised stabilisation and a cesarean delivery for the safety of both her and her Baby. She insisted on vaginal birth which was induced. The delivery process began but the baby started having a low heart rate. Emergency cesarean section was performed and the baby weighing 4.5 kg was born limp and needed NICU care and its future neurological deficit is yet to be determined. Timely cesarean delivery could have avoided this outcome. In addition she was diagnosed to be a diabetic after 6 weeks of delivery
Birthing is a physiological normal function of our body and pregnancy planning and delivery should be well planned to ensure a healthy Baby and a healthy mother . It’s a joint responsibility of the doctor as well as the mother and her family to ensure optimum birth outcomes .