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South Africa's cesarean birth rates are too high—they can be dangerous for mothers and babies

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A cesarean section is an important surgical intervention that can save the lives of mother and baby. Cesarean sections are essential in complicated labors such as prolonged or obstructed labor or if the baby is distressed.

The World Health Organization says that while "every effort should be made to provide a cesarean section to women in need," country cesarean rates should range between 10% and 15%.

In South Africa rates are much higher in both public and private sector hospitals.

In public hospitals, cesareans accounted for 28.8% of all births between 2020 and 2022. In private sector hospitals the rate is 75%.

Globally the average is 21%. In Europe the rate is 25.7%.

As specialists in obstetrics and pediatrics we argue that South Africa's cesarean section rates are too high. The over reliance on cesarean births places mothers and babies at great risk, including death and possible effects on brain development which have major implications for the child's future.

There are a number of reasons for South Africa's high rates. The main one is that cesarean section delivery is often perceived as the safer way to give birth. Other reasons include choosing a delivery date that is convenient for both the mother and doctor and fear of medical malpractice suits if the outcomes of vaginal delivery are not as expected.

Why cesarean section births are dangerous

Women who have cesareans in in South Africa are three times more likely to die than those who undergo normal vaginal delivery.

Some of the immediate risks to the mother after cesarean sections include:

  • prolonged and longer recovery time
  • injury to the bladder or ureter
  • heavy bleeding after birth with a need for a blood transfusion
  • an unplanned hysterectomy
  • blood clots, infection and death.

For future pregnancies, there is an increased risk of a repeat cesarean section, stillbirth and premature birth.

There is also the danger of placenta previa. This is when the placenta blocks all or part of the baby's exit from the vagina. Another risk is placenta accreta, which occurs when all or parts of the placenta remain attached, leading to increased bleeding in the mother and even death.

What's lost

A natural birth involves three important steps: the spontaneous onset of labor, the process of labor itself, and vaginal passage.

1) The spontaneous onset of labor is important because it suggests the baby's organs are mature. Delivery before this risks organ immaturity and serious health conditions.

The fetal brain develops fast in the last weeks of pregnancy. Earlier interruption of leads to significant increases in special educational needs.

2) The process of labor: a unique surge of hormones is secreted. These hormones and the physical forces are essential for the physiological readiness of both the mother and her baby. It equips the mother to make the transition from a to an effective mother and for the baby to move from being placenta-dependent to surviving independently.

These hormones are also necessary for the woman to bond with her baby and to initiate successful breastfeeding, while they support the infant to self-regulate critical early body functions like temperature control, glucose metabolism and oxygen exchange.

A significant number of women who do not go through labor will not be able to breastfeed their babies exclusively.

3) We now know that the vaginal passage is more important than previously thought.

Babies are born with a microbiome, albeit sparse, as well as an immature immune system, and the two develop together. The first microbes to colonize a baby's gut, airway, skin and mouth help teach the immune system what's harmful and what's not.

Vaginal birth marks an important step, exposing an infant to the array of mom's vaginal and rectal bacteria as he or she passes through the birth canal. A baby delivered by cesarean section receives a totally different collection of microbes that persist for months, and even the first years, of life. This not only affects the immune system but also other important processes like brain and metabolic health.

The infant must "learn" to tolerate non-harmful proteins coming from foods, domestic animals and our own body cells, but at the same time defend against protein signals from harmful microbes. Immune failure and lack of immune tolerance (allergy, asthma and autoimmunity) are clearly associated with cesarean births.

Reversing the trend

Cesarean section delivery is often perceived as the safer way to give birth. Expectant mothers often believe they prevent birth injuries such as cerebral palsy. However, research shows the prevalence of cerebral palsy does not decrease with increased cesarean section rates.

There must be a strong, unanimous message from the scientific community alerting role players and the public to the risks associated with unnecessary cesarean deliveries.

Provided by The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation

Citation: South Africa's cesarean birth rates are too high—they can be dangerous for mothers and babies (2024, May 7) retrieved 19 June 2024 from
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