December 23, 2010

Rising C-Section Rates Come Under Question

Rates of cesarean-section births have been rising steadily in developed countries around the world over the past 30 years, but a new analysis of data of about 20,000 women from around the world suggests it's not because women are asking for them.

According to a recent Reuters reports, 16% of women involved in the review said they would prefer C-section to vaginal delivery, Dr. Agustina Mazzoni of the Institute for Clinical Effectiveness and Health Care Policy in Buenos Aires, Argentina, and her colleagues found.

This is the first meta-analysis that looked at women's preferences, Mazzoni and colleagues noted in BJOG, the journal of the Royal College of Obstetricians and Gynecologists. They searched medical literature and identified 38 studies including 19,403 women from Asia, Europe, Africa, Australia, and the Americas.

In most middle- and high-income nations, the rise in c-section deliveries is often attributed to women's requests for the procedure. In the United States, some 4.5 percent of deliveries were C-section in 1965, and by 2007, roughly 32.9 percent were by C-section, according to the Centers for Disease Control and Prevention (CDC).

However, the researchers discovered that considerably fewer women said they would prefer the procedure of natural childbirth.

The team found that, overall, 15.6 percent of women included in the data analysis said they would prefer C-section to vaginal delivery. About 25 percent of women in Latin America reported they favored C-section, compared to about 17 percent of women from North America. Nearly 22 percent of women in middle-income countries said they would prefer C-sections, compared to 12 percent of women in high-income countries.

Among those who have had C-section in the past, 29 percent said they would prefer to have their next delivery the same way, compared to ten percent who hadn't had a previous C-section.

Women who had several children were also more likely than those pregnant for the first time to prefer C-sections -- 17.5 percent versus 10 percent.

The analysis looked at women's preferences only and not whether they actually asked for a C-section when the time came. With this information, the researchers determined that C-section deliveries resulting from maternal requests cannot be inferred from the data, Mazzoni and her colleagues wrote.

Nonetheless, they added, "although cesarean section on demand has been suggested as a relevant factor for the increasing cesarean section rates, it seems unlikely that this explains the high cesarean section rates in some countries and regions."

In Latin America, they pointed out, "where most women prefer vaginal delivery, and also where most are not allowed to play a role in the decision of the mode of delivery, around 29 percent of childbirths are cesarean sections."


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