Last week, professionals, including childbirth educators, involved in the maternal infant health field read with great interest a just released paper that examines the “optimal” cesarean rate that saves lives but does not increase maternal or newborn mortality rates. Relationship Between Cesarean Rate and Maternal and Neonatal Mortality was published on December 1, 2015 in the Journal of American Medical Association (JAMA). This new study calls into question the long standing recommendation of 10-15 percent as previously stated by the World Health Organization.
To determine an accurate international number of cesarean sections is very difficult as low resources countries often have higher mortality rates because many laboring women do not have access to the lifesaving surgery when circumstances demand it. While their cesarean rate is low, preventable deaths are occurring in mothers and newborns as a result. In fact, when the cesarean dropped below 7%, mothers and babies suffered. In high resource countries, cesareans are performed at much higher rates, and often unnecessarily and the outcomes are also not good. This higher cesarean rate and its accompanying higher maternal and neonatal mortality rates may be a result of a lower tolerance to risk due to medicolegal concerns. The entire situation is very complicated and definitely not black and white. The appropriate cesarean rate for each country will vary depending on the available health care funds available, the prenatal and intrapartum care available and other resources in each individual country. No one number will apply to all the 194 World Health Organization nations.
What we do know, is that here in the United States, our cesarean rates are too high and our maternal and neonatal outcomes are poor compared to other similarly resourced countries. For what we spend on health care dollars in the USA, it is shocking how poor our outcomes are.
You may also enjoy reading an accompanying editorial in JAMA on the same topic – Cesarean Delivery Rates – Revisiting a 3-Decades-Old Dogma, though it is behind a subscription wall, so access may be difficult.
Lamaze International released a press statement regarding this new study and applauded the work of the researchers on helping all of us to understand how reducing unnecessary cesareans is critical while increasing access in locations across the globe where populations are negatively affected by the lack of resources to perform safe cesareans.
We applaud these researchers on continuing to shine a light on optimal maternal and neonatal birth outcomes. However, despite the variance in cesarean rate guidelines, global cesarean rates are still too high, and directly affect maternal and neonatal mortality rates. – Maria Brooks, BSN, RNC-OB, LCCE, FACCE, Lamaze International President.
Lamaze International and Lamaze Certified Childbirth Educators support sharing evidence based care with the families in our classes, including the Six Healthy Birth Practices, that can help families to reduce unnecessary interventions that may lead to cesareans that might not have been needed. We support safe and healthy births for families everywhere.
Look for an upcoming research review on this new study in a future post on Science & Sensibility.
References
Betran, A. P., Torloni, M. R., Zhang, J. J., & Gülmezoglu, A. M. (2015). WHO Statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology.
D’Alton, M. E., & Hehir, M. P. (2015). Cesarean Delivery Rates: Revisiting a 3-Decades-Old Dogma. JAMA, 314(21), 2238-2240.
Molina, G., Weiser, T. G., Lipsitz, S. R., Esquivel, M. M., Uribe-Leitz, T., Azad, T., … & Haynes, A. B. (2015). Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. JAMA, 314(21), 2263-2270.