**7. Caesarean section rates and why the increase over the decades**

The international healthcare community has considered the ideal rate for caesarean sections to be between 10 and 15% [29] based on a 1985 WHO meeting in Brazil that stated that there is no justification for any region to have a rate higher than 10–15%. Since then caesarean sections have become increasingly common in both developed and developing countries for a variety of reasons [30].

When medically justified, caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. The proportion of caesarean sections at the population level is a measure of the level of access to and use of this intervention. It can serve as a guideline for policy-makers and governments in assessing progress in maternal and infant health and in monitoring emergency obstetric care and resource use.

Concerns on the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health have been raised [31]. This concern is extended also to cost which is a major factor in improving equitable access to maternal and newborn care, as caesarean sections represent significant expense for overloaded and often weakened health system. However, determining the adequate caesarean section rate at the population level, i.e. the minimum rate for medically or obstetrically indicated caesarean section, while avoiding medically unnecessary operations is a challenging task.

In the United States, the caesarean delivery rate rose from 4.5% in 1970 to 32.9% in 2009. Following this peak, the rate has trended slightly downward, and it was 32.0% in 2015 [9]. In China the caesarean section rate was 42% in 2010 [31] despite the author claiming it had reduced. The rates can be even higher in private clinics. For example, in Brazil, 80–90% of births in private clinics are now caesarean sections, compared with about 30–40% of births in public hospitals [32]. Countries with high caesarean section rates include the Dominican Republic 56.4%, Brazil 55.6%, Egypt 51.8%, Turkey 50.4%, Iran 47.9% and China 47%.

See more at https://www.bellybelly.com.au/birth/highest-c-section-rates-bycountry/.

At the other end of the spectrum, sub-Saharan Africa is still struggling to give mothers access to caesarean sections when required. Across this region, the caesarean section rate has changed very little since 2000, hovering right around 5%. This also varies from country to country and from private to public hospitals. In Africa only 7.3% of babies are born via this method. But it is a very mixed picture across the continent. Some countries have very high rates such as Egypt (51.8%) and Mauritius (47%), the highest in Africa. And despite a 2.9% overall increase across the continent from 1990, there has been a decline in some countries like Nigeria and Guinea which now stands at about 2%. Zimbabwe has maintained its caesarean section rates at 6%.

So what is driving the global rise of Caesarean sections? Some scholars claim it is likely three factors working together: financial, legal and technical with some people calling for hospitals to pay doctors equally for vaginal births in order to bring these rates down. However, the reasons for persistently significant caesarean rates are not completely understood, but some explanations include the following [9]:


**95**

*Caesarean Section in Low-, Middle- and High-Income Countries*

3.The use of electronic foetal monitoring is widespread. This practice is associated with an increased caesarean delivery rate compared with intermittent foetal heart rate auscultation. Foetal distress accounts for only a minority of all caesarean deliveries. In many more cases, concern for an abnormal or "non-

reassuring" foetal heart rate tracing prompts caesarean delivery.

5.The frequency of operative vaginal delivery has declined.

among nulliparous, raises the caesarean delivery rate.

associated with greater caesarean delivery rates.

15.Belief that caesarean section is less traumatic to the baby.

17.Low tolerance of anything less than perfect birth outcome.

caesarean sections. It is either too little too late or too much too soon.

16.Convenience to the care provider and mother.

ery rate.

vaginal birth.

13.Fear of birth and labour pain.

**8. Robson's classification for CS**

4.Most foetuses presenting breech are now delivered by caesarean section.

6.Rates of labour induction continue to rise, and induced labour, especially

8.Rates of caesarean delivery in women with preeclampsia have increased, whereas labour induction rates for these patients have declined.

10.Elective caesarean deliveries are increasingly being performed for various indications that include maternal request, concern for pelvic floor injury

11.Assisted reproductive technology is more widely used than in the past and is

12.Malpractice litigation related to foetal injury during spontaneous or operative vaginal delivery continues to contribute to the present caesarean deliv-

14.Belief that caesarean section prevents trauma and damage to the pelvic due to

18.Cultural considerations, e.g. birth date being lucky for future or destiny.

Looking at the different caesarean section rates across the globe, it appears mothers around the world end up with less than optimal care when it comes to

As already discussed, there are concerns over the rising caesarean section rate globally. However, determining the adequate caesarean section rate at the

associated with vaginal birth and reduction of foetal injury rates.

9.The rate of vaginal birth after caesarean (VBAC) has decreased.

7.Obesity, which is a caesarean delivery risk, has reached epidemic proportions.

*DOI: http://dx.doi.org/10.5772/intechopen.88573*

*Recent Advances in Cesarean Delivery*

**7. Caesarean section rates and why the increase over the decades**

both developed and developing countries for a variety of reasons [30].

and in monitoring emergency obstetric care and resource use.

55.6%, Egypt 51.8%, Turkey 50.4%, Iran 47.9% and China 47%.

unnecessary operations is a challenging task.

The international healthcare community has considered the ideal rate for caesarean sections to be between 10 and 15% [29] based on a 1985 WHO meeting in Brazil that stated that there is no justification for any region to have a rate higher than 10–15%. Since then caesarean sections have become increasingly common in

When medically justified, caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. The proportion of caesarean sections at the population level is a measure of the level of access to and use of this intervention. It can serve as a guideline for policy-makers and governments in assessing progress in maternal and infant health

Concerns on the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health have been raised [31]. This concern is extended also to cost which is a major factor in improving equitable access to maternal and newborn care, as caesarean sections represent significant expense for overloaded and often weakened health system. However, determining the adequate caesarean section rate at the population level, i.e. the minimum rate for medically or obstetrically indicated caesarean section, while avoiding medically

In the United States, the caesarean delivery rate rose from 4.5% in 1970 to 32.9% in 2009. Following this peak, the rate has trended slightly downward, and it was 32.0% in 2015 [9]. In China the caesarean section rate was 42% in 2010 [31] despite the author claiming it had reduced. The rates can be even higher in private clinics. For example, in Brazil, 80–90% of births in private clinics are now caesarean sections, compared with about 30–40% of births in public hospitals [32]. Countries with high caesarean section rates include the Dominican Republic 56.4%, Brazil

See more at https://www.bellybelly.com.au/birth/highest-c-section-rates-by-

At the other end of the spectrum, sub-Saharan Africa is still struggling to give mothers access to caesarean sections when required. Across this region, the caesarean section rate has changed very little since 2000, hovering right around 5%. This also varies from country to country and from private to public hospitals. In Africa only 7.3% of babies are born via this method. But it is a very mixed picture across the continent. Some countries have very high rates such as Egypt (51.8%) and Mauritius (47%), the highest in Africa. And despite a 2.9% overall increase across the continent from 1990, there has been a decline in some countries like Nigeria and Guinea which now stands at about 2%. Zimbabwe has maintained its caesarean

So what is driving the global rise of Caesarean sections? Some scholars claim it is likely three factors working together: financial, legal and technical with some people calling for hospitals to pay doctors equally for vaginal births in order to bring these rates down. However, the reasons for persistently significant caesarean rates are not completely understood, but some explanations include the following [9]:

1.Women are having fewer children; thus, a greater percentage of births are among nulliparous, who are at increased risk for caesarean delivery.

2.The average maternal age is rising, and older women, especially nulliparous,

have a higher risk of caesarean delivery.

**94**

country/.

section rates at 6%.


Looking at the different caesarean section rates across the globe, it appears mothers around the world end up with less than optimal care when it comes to caesarean sections. It is either too little too late or too much too soon.
