Caesarean sections have become the commonest of surgeries performed by most hospitals across the country.
The C-section rates had been climbing slowly and steadily since the eighties, amid rising concerns whether all these surgeries were medically indicated.
Since 1985, the WHO-recommended ‘ideal rate’ of C-sections has been between 10 and 15 per cent. But with C-section rates soaring even in developed nations, WHO withdrew its recommendation in 2010, saying that there was ‘no empirical evidence for an optimum percentage’ but that all women who medically need a C-section delivery should not be denied it.
Well-being
The latest statement (April 10) from WHO on C-section rates, after analysing the latest available data and evidence, has put the focus back on the needs of women and her well-being, rather than a target rate.
It says that C-sections are effective in saving maternal and infant lives but only when it is done for medically indicated reasons.
“At the population level, new studies reveal that C-section rates above 10 per cent are not associated with reductions in maternal and newborn mortality rates. But every effort should be made to provide C-sections to women in need, rather than striving to achieve a specific rate,” the WHO says.
High-risk cases
Obstetricians say that with a number of obese, older women, and women with high-risk conditions now becoming pregnant, child births have become complicated and unpredictable.
On the other side, there is also the argument that doctors no longer wait for labour to progress to see if a C-section might be medically indicated, before going ahead with one.
In Kerala, the average C-section rate, even in government hospitals, have begun to cross 50 per cent. The WHO has reiterated that C-section may be performed when vaginal delivery could pose a risk to the mother and baby but that ‘it can cause significant and permanent complications, disability or death,’ especially if the health institution lacks the facility to handle surgical complications.
“More research is needed to understand the health effects of C-sections on women’s psychological and social well-being,” the new WHO statement says.
Classification
It has pointed to the need for a universal classification system for C-section, so that a meaningful comparison of the rates across different hospitals and regions is possible and has recommended that all hospitals adopt the ‘Robson classification’ system for monitoring C-sections.
Under the Robson system, all women admitted for delivery are classified into 10 groups based on easily identifiable factors such as the number of previous pregnancies, foetal position, gestational age, previous uterine scars etc.
The WHO says that this classification and data analysis will help hospitals optimise the use of C-sections in future by focussing interventions on specific groups, assessing quality of care, and clinical management practices in each group.
Reporting by C. Maya