Maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, with up to a third of all babies dying, according to data compiled from over 12 million pregnancies. This is according to a new review published in The Lancet , which has considered 196 studies from 67 low and middle-income countries.
Information released by the World Health Organization under its sexual and reproductive health section further adds from the study that data from 1990 to 2017 show that a quarter of all women who died while giving birth in low and middle-income countries had undergone caesarean section.
“The outcomes for women in low and middle-income countries are far worse than we expected,” said first author, Dr. Soha Sobhy of Queen Mary University of London.
Dr. Ana Pilar Betrán, medical officer, WHO, added that the overuse versus underuse of caesarean section is a current global concern and the focus of debates and research.
“In many low and middle-income countries, overuse and underuse coexist, making it particularly difficult to increase the provision of caesarean section to those women in need without aggravating the overuse which, in turn, places women at higher risk of complications,” she said.
Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries. Timely access to caesarean section when needed is required for safe childbirth, but ‘too little, too late,’ or ‘too many, too soon’ are part of a problem, and not a solution notes the study.
A third of all deaths following caesarean section were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia, 22% to sepsis, and 14% to anesthesia related causes.
The study further says that while many women in need of caesarean sections still do not have access to it, particularly in low-resource settings, many others undergo the procedure unnecessarily, for reasons which are not medically justified.
Lead author Professor Shakila Thangaratinam, Queen Mary University of London, added: “Caesarean sections are the most commonly performed operation worldwide. They are meant to be life saving for both mother and baby. Now that we know the risk factors and countries associated with poor outcomes, we can make a more targeted effort so that timely and safe caesarean sections can be done wherever they are needed.”
The authors also highlighted that training is needed in decision making to reduce unnecessary caesarean sections, and in appropriate intrapartum care including instrumental deliveries to reduce caesarean sections performed in the second stage of labour, which carry greater risk.
