WUNRN
http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/
CAESAREAN SECTION BIRTHS SHOULD ONLY BE PERFORMED WHEN MEDICALLY NECESSARY
10 APRIL 2015 |
GENEVA -
Caesarean section is one of the most common surgeries in the world, with rates
continuing to rise, particularly in high- and middle-income countries. Although
it can save lives, caesarean section is often performed without medical need,
putting women and their babies at-risk of short- and long-term health problems.
A new statement from the World Health Organization (WHO) underscores the
importance of focusing on the needs of the patient, on a case by case basis,
and discourages the practice of aiming for “target rates”.
Caesarean section
may be necessary when vaginal delivery might pose a risk to the mother or baby
– for example due to prolonged labour, foetal distress, or because the baby is
presenting in an abnormal position. However, caesarean sections can cause
significant complications, disability or death, particularly in settings that
lack the facilities to conduct safe surgeries or treat potential complications.
Ideal rate for
caesarean sections
Since 1985, the
international healthcare community has considered the “ideal rate” for
caesarean sections to be between 10% and 15%. New studies reveal that when
caesarean section rates rise towards 10% across a population, the number of
maternal and newborn deaths decreases. But when the rate goes above 10%, there
is no evidence that mortality rates improve.
“These conclusions
highlight the value of caesarean section in saving the lives of mothers and
newborns,” says Dr Marleen Temmerman, Director of WHO’s Department of
Reproductive Health and Research. “They also illustrate how important it is to
ensure a caesarean section is provided to the women in need - and to not just
focus on achieving any specific rate.”
Across a
population, the effects of caesarean section rates on maternal and newborn
outcomes such as stillbirths or morbidities like birth asphyxia are still
unknown. More research on the impact of caesarean section on women’s
psychological and social well-being is still needed.
Due to their
increased cost, high rates of unnecessary caesarean sections can pull resources
away from other services in overloaded and weak health systems.
International use
of Robson classification
The lack of a
standardized internationally-accepted classification system to monitor and
compare caesarean section rates in a consistent and action-oriented manner is
one of the factors that has hindered a better understanding of this trend. WHO
proposes adopting the Robson classification as an internationally applicable
caesarean section classification system.
The Robson system
classifies all women admitted for delivery into one of 10 groups based on
characteristics that are easily identifiable, such as number of previous
pregnancies, whether the baby comes head first, gestational age, previous
uterine scars, number of babies and how labour started. Using this system would
facilitate comparison and analysis of caesarean rates within and between
different facilities and across countries and regions.
“Information
gathered in a standardized, uniform and reproducible way is critical for health
care facilities as they seek to optimize the use of caesarean section and
assess and improve the quality of care,” explains Dr Temmerman. “We urge the
healthcare community and decision-makers to reflect on these conclusions and
put them into practice at the earliest opportunity.”
Notes for Editors:
The WHO Statement
on Caesarean Section Rates is based on two studies carried out by the
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme for Research, Development
and Research Training in Human Reproduction. This programme is the main
instrument within the United Nations system for research in human reproduction,
working within the Department of Reproductive Health and Research of the World
Health Organization.