Pressure Off to Reduce Number of Cesarean Births

A target to reduce the number of Cesarean section births in Britain and abroad was quietly dropped, it emerged Tuesday, as experts continued to challenge it as a “myth.”

One in four babies born in Britain were delivered by Cesarean section, well above a long-standing recommendation from the World Health Organization (WHO) that the rate should be no more than one in eight. The National Health Service was under pressure to reduce the rising tally, attributed in part to increased numbers of obese and older women having complicated births, as well as to a perception that some women were “too posh to push."

Although some Cesarean sections are medically necessary, the suggested optimum rate for the procedure was set more than 20 years ago at 10 to 15 percent of all births on the grounds that it helped protect the health of mothers and babies.

But the latest advice from the WHO omitted the target, because it was not based on solid evidence. Its latest Monitoring Emergency Obstetric Care handbook, published last year, said: “Earlier editions of this handbook set a minimum and maximum acceptable level for Cesarean section. Although WHO has recommended since 1985 that the rate not exceed 10-15 percent, there is no empirical evidence for an optimum percentage ... the optimum rate is unknown.”

It added that “what matters most is that all women who need Cesarean sections actually receive them.”

The Royal College of Midwives and other medical bodies said that women who have natural births generally have better outcomes and that there are good reasons to avoid an unnecessary invasive procedure — but some leading doctors said the pressure to reduce rates could be due to the higher costs of the procedure rather than safety concerns.

Cesarean section rates at individual maternity units vary widely across England for both planned procedures and medical emergencies. Although the national average is about 25 percent of births, local figures range from 15.8 percent in King’s Mill, central England, to more than a third of births in some parts of London and the South East.

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