March 18, 2004
Unnecessary caesareans worldwide
Leading the pack for many years in C-section birth rate was Brazil, but its place has now been taken over by Chile (which has a rate of 40%).
While some say patient choice is responsible for these numbers, others say that patients are compelled to choose c-sections by doctors. Another reason may be Brazil's Church-influenced policy on sterilization and contraception.
Around the world, people are seeing a big problem with the way caesareans are handled. The sooner Caesareans go back to being done for medical reasons only, the safer expecting mothers will be.
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I can think of some other reasons. In litigious societies, doctors fear reprisal if they are accused of inaction. I don't know why they should be more vulnerable in malpractise to sins of omission than commission, but there you are. Monkeys, including us, are not very good at the calculus of risk and consequence, so many women choose c-sections to avoid pain and injury, without realising the greater risks they expose themselves and their babies to. (Double the mortality rate for mother and child, all other things being equal). Here in New Zealand our rates are high, though not among the worst. It interests me that there's a big variation between hospitals, even when you account for the surgical capabilities of big vs small hospitals - obviously institutional culture has a lot to do with it. I doubt very much that there is any one reason that predominates. That's probably why policy initiatives aren't very successful; they address one well-publicised cause while ignoring the others.
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Very interesting set of links, melpomene; thank you! You might also be interested in this heated debate from a discussion forum at essentialbaby.com. Sadly it gets rather bad-tempered towards the end, but it is worth reading because it offers an insight into the views of some mothers, and gives them a chance to speak for themselves. I agree there is a problem with unnecessary caesarians, but I think it's important to avoid the reflex "blame-the-doctor" mentality. (Not that you are guilty of that, melpomene, but some people are.) In some countries (perhaps more in the developed than in the developing world) the demand for c-sections seems to be coming from mothers themselves, not just from the medical profession.
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Well, verstegan, I'd be more hesitant to blame doctors primarily - IF the statistics were different. However, in countries where obstetricians are required at hospital births or are more prevalent than midwives, caesareans are far above the rate recommended by the WHO. In nations with midwives, the rates are more normal. These midwife nations include a lot of countries that are definitely developed. The disparity is hard to explain any other way.
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caesareanfilter
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Just to expand a little, I think the connection with the presence of obstetricians is interesting. I think it's human nature to want to "do something". There needn't be any impure motive on the part of the specialist. verstegan, far be it from me to tell women what to do with their bodies, but I think those who choose a c-section for convenience reasons are likely to be have a poor understanding of the risks.