In recognition of the urgent need to address the steady rise in the rate of caesarean sections globally, the World Health Organization has issued new guidelines.
Tackling the non-medical reasons that drive surgical deliveries is key to reducing inappropriate use, according to the UN agency.
Some of the interventions are aimed at health facilities and health professional, including a collaborative midwifery-obstetrician model. In this model, staffing is based on care provided primarily by midwives, with 24-hour backup from an obstetrician who provides in-house labour and delivery coverage without other competing clinical duties.
Midwifery is associated with more vaginal births, safer outcomes, positive maternal experiences and lower costs, finds a report by The Lancet on optimising the use of caesarean sections.
Another proposal is that hospitals should remunerate equally for C-section and vaginal births. Health facilities should also be obliged to publish annual surgery rates and set up audits and timely feedback loops between facilities and healthcare professionals.
A mother-baby friendly hospital setting is also important. Adequate pain relief, improved privacy and care in labour wards could help reduce surgery prevalence. Approaches such as labour companionship has been associated with higher proportions of natural and safer births.
Health education for women is an essential component of antenatal care. It is necessary to provide support programmes such as childbirth preparation classes for mothers and couples, relaxation training programmes led by nurses and psycho-education for women with fear of pain or anxiety.
Clinical interventions such as vaginal birth after C-section and vaginal breech delivery in appropriately selected women could reduce the frequency of C-sections, according to the Lancet series.
The series concludes that the wide variations reported between regions and within countries, and between women, show that caesarean use is not evidence-based. The series also finds that an increase in obesity, age and nulliparity (the condition in a woman of never having given birth) among populations of women are not enough to explain the upsurge of surgery-aided births.
However, the series concludes that efforts to reduce C-section births must strongly respect women’s right to choose the circumstances of birth.