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| Medical Daily |
Cesarean section surgery, when medically
indicated and performed by trained staff with the necessary equipment and
supplies, can be a life-saving procedure for the mother and baby. However,
compared to vaginal delivery, cesareans are associated with a higher risk of maternal
and neonatal
death; numerous maternal
morbidities including infection, uterine rupture and amniotic fluid embolism;
neonatal
morbidities often related to iatrogenic prematurity; and potential complications
in subsequent pregnancies. Studies have
also observed that children born via cesarean are more likely to develop respiratory
problems, diabetes
and obesity
later in life. Therefore, cesareans should be considered a major surgical
intervention and only be performed when clinically necessary.
Furthermore, to
minimize the risks associated with cesarean section, the surgery should only be
performed by skilled health workers in high
quality facilities.
For many years, researchers have debated
the optimal
cesarean rate for maximizing maternal and infant health outcomes. Since
1985, the World Health Organization has estimated the ideal population-level
cesarean rate at 10-15%,
although some scientists have suggested
a higher figure. Further investigation of an optimal rate is certainly
warranted. Theoretically, the optimal population-level cesarean rate should be
calculated based on the proportion of laboring women who have a medical
indication for cesarean delivery. But, unfortunately, the high and increasing
levels of cesarean delivery rates around the world illustrate that
the procedure is not always medically indicated.
Clinicians sometimes disagree about what
constitutes a medical indication, and in some cases lack the necessary tools to
identify a complication. For example, fetal distress is a commonly reported
reason for performing a cesarean—but how exactly does one measure fetal
distress? How long should a provider wait for an abnormal fetal heartbeat to
return to normal before deciding to perform a cesarean? How can clinicians in
low-resource settings without access to fetal monitoring technology accurately
assess these situations?
Before developing consensus on the optimal
population-level rate, the global maternal health community must agree upon the
medical indications for cesarean delivery and ensure that clinicians around the
world are adhering to standardized, evidence-based guidelines.
This is the part one of a very interesting debate, please click here and here for part two and three .
News credit : Maternal Health Task Force Blog
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