As the rate of cesarean sections increases worldwide, multifaceted clinical and nonclinical interventions that address clinicians’ and women’s beliefs and attitudes should be implemented to decrease unnecessary procedures, according to a series of papers published in The Lancet.
In one paper, Ties Boerma, PhD, director of the department of information, evidence and research at WHO, and colleagues found that in 2015, 29.7 million births occurred through cesarean section in the 169 countries that contribute to 98.4% of the world’s births, indicating two times as many births by this method since 2000.
“Optimizing the use of cesarean section is of global concern,” Ana Pilar Betrán, PhD, medical officer in the department of reproductive and health research at WHO, and colleagues wrote in a separate paper. “Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of cesarean section has not shown benefits and can create harm.”
“Worldwide, the frequency of cesarean section continues to increase, and interventions to reduce unnecessary cesarean sections have shown little success,” they continued. “Identifying the underlying factors for the continuing increase in cesarean section use could improve the efficacy of interventions.”
Many women who require cesarean section do not have access to the procedure while many others undergo the procedure without medically justified reasons, according to the authors.
In its new guidance, WHO offers recommendations for nonclinical interventions to address the sustained and unprecedented rise in cesarean section rates and reduce unnecessary procedures, according to a press release. The guideline considers the views and fears of women and health care professionals about cesarean sections, the dynamics and limitations of health care systems and the relationships between women, health care professionals and health care services, according to the release.
The WHO’s recommendations include:
Educational interventions, such as childbirth training workshops, relaxation training programs, psychosocial couple-based prevention programs, psychoeducation for fear of pain or anxiety, should be provided to women and families. Such interventions should help inform decision-making on delivery mode.
Health care professionals should use clinical guidelines and audits of cesarean sections to inform cesarean section practices.
A second opinion for cesarean section indication with timely feedback should be required in settings with adequate resources.
Labor companionship and midwife-led continuity of care should also be implemented.
“It is crucial that women who need cesarean sections are able to access this potentially life-saving procedure, but equally unnecessary procedures should be avoided, so that the lives and well-being of women and their babies are not put at risk,” Betrán said in a press release.
