Searching for the optimal rate of medically necessary cesarean delivery.

Birth 2014 Sep 11;41(3):237-44. Epub 2014 Apr 11.

Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Over the past three decades, the World Health Organization expert panel proposed cesarean delivery rate of 10-15 percent was used as a doctrine for an optimal rate of cesarean delivery despite the lack of concrete evidence. We set out to compile cesarean delivery rates, socioeconomic indicators, and health outcomes by countries in the last three decades to explore the optimal rates for medically necessary cesarean delivery.

Methods: We selected 19 countries which have readily accessible cesarean delivery and low maternal and infant mortality, including countries in North and West Europe, North America, Australia, New Zealand, and Japan. Information on cesarean delivery rate, human development index (HDI), gross domestic products (GDP), maternal, neonatal, and infant mortality rates of each country in the past 30 years was collected from published reports. A two-level fractional polynomial model was used to model the association between cesarean rate and mortality rates.

Results: Most of the countries have experienced sharp increases in cesarean delivery rates. Once cesarean delivery rate reached 10 percent, with adjustment for HDI and GDP, further increase in cesarean delivery rate had no impact on maternal, neonatal, and infant mortality rates.

Conclusions: Our findings corroborate the statement that a population-level cesarean section rate above 10-15 percent is hardly justified from the medical perspective.

Download full-text PDF

Source
http://dx.doi.org/10.1111/birt.12104DOI Listing
September 2014
329 Reads

Publication Analysis

Top Keywords

cesarean delivery
36
delivery rate
16
cesarean
12
infant mortality
12
delivery
9
rate 10-15
8
10-15 percent
8
maternal neonatal
8
neonatal infant
8
delivery rates
8
three decades
8
cesarean rate
8
medically cesarean
8
rate
8
optimal rate
8
gross domestic
4
domestic products
4
hdi gross
4
development hdi
4
collected published
4

References

(Supplied by CrossRef)
Appropriate technology for birth
World Health Organization et al.
Lancet 1985
Births: Preliminary data for 2006
Hamilton et al.
Natl Vital Stat Rep 2007
Births: Final data for 2005
Martin et al.
Natl Vital Stat Rep 2006
Can we reduce the caesarean section rate?
Robson et al.
Best Pract Res Clin Obstet Gynaecol 2001

National Collaborating Centre for Women's and Children's Health et al.
2004

Similar Publications