Around the world, c-section rates continue to rise.

Concerns have been raised and debates rage on, due to a lack of agreement on what an appropriate c-section rate is, as well as the long and short term risks, and overall costs of the surgery.

The World Health Organization has long recommended that the ideal c-section rate should be between 10-15%.

When c-section rates in a country move towards 10%, there is a significant decrease in maternal and newborn deaths.

When the rate goes over 10%, there is no evidence that death rates improve – therefore the risks outweigh the benefits.

Why Are C-section Rates Rising?

This is a question that can’t be answered easily.

According to maternity health experts, high rates can be attributed mainly to increasing maternal age, increased numbers of multiple births, and higher rates of obesity among women.

But this doesn’t take into consideration the many other factors driving c-section rates up:

Medical-led view of pregnancy and birth, leading to higher rates of interventions
Fear of birth and labour pain
Fear of medical litigation
Belief c-section prevents trauma and damage to the pelvic floor
Belief c-section is less traumatic to the baby
Convenience to care provider and mother
Low tolerance of anything less than the perfect birth outcome
Cultural considerations, such as birth date being lucky for future or destiny.

What’s The Problem?

C-sections involve risk for both mothers and babies, and can cause complications for future pregnancies and births.

When medically necessary, c-sections undoubtedly save lives.

Yet the statistics point to a high number of low risk women having the surgery unnecessarily. This means women and babies are being exposed to avoidable risks as well as increasing the burden of cost on health systems.

C-sections have become normal in so many countries, as the vast majority of women give birth in hospital settings that are set up to expect the worst case scenario and the best outcome is a healthy baby and mother.

Where Are C-Section Rates The Highest?

Recent statistics from 150 countries shows a global c-section rate of 18.6% of all births – almost 1 in 5 women around the world will give birth via c-section.

Data from 121 countries shows between 1990 and 2014, the global average c-section rate increased by 12.4%.

So which countries perform the most c-sections?

46 – 57% C-Section Rate:

Dominion Republic 56.4
Brazil 55.6
Egypt 51.8
Turkey 50.4
Iran 47.9
China 47

35 – 45% C-Section rate:

Mexico 45.2
Chile 44.7
Maldives 41.1
Uruguay 39.9
Georgia 36.7
Republic of Korea 36.6
Romania 36.3
Italy 36.1
Hungary 35.3
Portugal 35

30 – 45% C-Section Rate:

Poland 34.6
Malta 33.5
Bulgaria 33.1
Paraguay 33.1
Australia 33
United States of America 32.2
Switzerland 32.5
Germany 30.9
Slovak Republic 30.7
Sri Lanka 30.5
Albania 30

25 – 30% C-Section Rate:

El Salvador 29.8
Argentina 29.1
Armenia 29.1
Austria 28.8
Luxemberg 28.8
Ireland 28.5
Canada 26.3
United Kingdom 26.2
Czech Republic 26.1
New Zealand 25.9

Are There Countries Doing Better?

Several countries in Europe have managed to control or reduce their c-section rates over time. Countries such as Finland, Iceland and Norway have had very low increases with their c-section rates being around 15%.

These countries which have managed to keep their c-section rates low face the same issues other European countries do, with more women becoming mothers older and the prevalence of obesity and health complications.

These countries successfully keeping their c-section rates down focus more on higher rates of vaginal births through having strict guidelines about elective c-sections, cultural normalising of vaginal birth, different legal attitude to medical litigation, and access to high quality midwifery led care.

How Do We Get It Right?

The World Health Organization Statement on c-section rates published in 2015 emphasises: “Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate”.

In countries with access to high quality maternity care, it is possible to reduce c-section rates. Yet it shouldn’t happen at the cost of increasing rates of instrumental births or other interventions. Reducing c-section rates needs to be safe so women and babies who do need assistance have access to it.

Decreasing c-section rates isn’t as simply as setting a goal and sticking to it. There needs to be a global shift normalising vaginal birth and providing the foundations which make it more achievable, such as continuity of care and high quality independent birth education.

But it’s not enough to simply provide these options, health systems need to develop a culture that genuinely values, promotes, and supports vaginal birth and particularly works to reduce unnecessary c-sections in first time mothers.

High income countries around the world have decreased or controlled their c-section rate to what is considered an acceptable level, reducing the risks of unnecessary surgery to mothers and babies. Vaginal birth is the normal outcome of a healthy, low risk pregnancy which women shouldn’t have to fight to achieve.

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