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WHO guidance on caesarean section rates

Australian College of Midwives,midwife,midwifery,c
Photo: Australian College of Midwives,midwife,midwifery,c
Caesarean sections are one of the most common surgeries in the world with rates continuing to rise, especially in high and middle income countries around the world.

The World Health Organisation (WHO) has released a statement advising that caesarean sections should only be performed when medically justified - when vaginal delivery poses a risk to the mother or baby, such as during prolonged labour, foetal distress or because the baby is presenting in an abnormal position.

The global health body warns caesarean sections are often not medically justified, placing women and their babies at risk of short and long-term health problems.

“Caesarean sections can cause significant and sometimes permanent complications, disability or death particularly in settings that lack the facilities and/or capacity to properly conduct safe surgery and treat surgical complications,” it states.
The effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia remain unknown, with the organisation stating more research is needed on the impact of caesarean sections on women’s psychological and social well-being.

Since 1985, the international health care community has considered the ideal rate for caesarean sections at a population level to stand at between 10 and 15 per cent.

WHO has conducted studies to pinpoint the ideal caesarean rate within a population.

It found when caesarean rates rise towards 10 per cent, the number of maternal and newborn deaths decline but when the rate surpasses 10 per cent, there’s no evidence of an improvement in mortality rates.

The guidance highlights the importance of focusing on the needs of the patient, on a case by case basis, advising against the practice of aiming for ‘target rates’.

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” Dr Marleen Temmerman, director of WHO’s Department of Reproductive Health and Research says in a statement.

“They also illustrate how important it is to ensure a caesarean section is provided to the women in need - and to not just focus on achieving any specific rate.”

The Australian Institute of Health and Welfare’s (AIHW) Mothers and Babies report 2012 showed 99,474 women gave birth by caesarean section in Australia in 2012, with caesarean section rates increasing from 28.5 per cent in 2003 to a peak of 32.4 per cent in 2012.

Western Sydney University Professor Hannah Dahlen, a privately practising midwife and spokesperson for the Australian College of Midwives (ACM), says Australia’s caesarean section rate remains high due to the nation’s over-medicalised birth system that favours high intervention rates during labour.

“If you look at the countries with the lowest caesarean section rates, all care is delivered by midwives - doctors are only involved if there’s a problem,” she says.

“If you look at our country, we have far too much medical involvement in low risk pregnancy and you only have to look at the private sector to see that they have double the caesarean section rate of the public sector, and that’s a factor where obstetricians provide and manage all of the care.

“So we need to return back to the system that the World Health Organisation, the recent Lancet publications etcetera have all recommended - which is midwives are expert in normal and bring doctors in when there’s problems but don’t have doctors manage normal.”

Professor Dahlen says it’s vital to prioritise midwifery models of care, including continuity of care models, and environments that facilitate normal birth, such as birth centres and home births, to reduce Australia’s caesarean section rate.

“We know that the simple act of being with a woman and giving her comfort and support and reassurance is probably the most powerful thing you can do in reducing caesarean section rates and that’s what midwives do,” she says.

“Unfortunately our systems have become busy and so technically orientated that midwives are often running between two and three women in labour and are not able to spend that time with them and comforting them and helping them and reassuring them.

“Midwives need to return to do midwifery but in order for them to be able to do that, managers and health systems have to reconstruct themselves to make sure that all women in labour receive one to one midwifery care.”


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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords