Why do so many births end up as Caesareans?

Apr 30 2009

30% of births end up in caesareans. This is demonstrated by a research project led by researchers from the Public Health Agency of Barcelona (PHAB), which relates two of the influencing factors in this practice: social class and the maternity service utilized (public or private). Researchers advise prudence in interpreting these results.

The study, published in the magazine Journal of Epidemiology and Community Health , analyzes the data of female residents in Barcelona who gave birth between 1994 and 2003, and reveals that a relevant factor in the percentage of caesareans is birth care in private clinics, since they double public clinics in the number of surgeries.

The research project's authors confirm to SINC that, in Spain, the number of interventions carried out through caesareans is "excessive".  "More caesareans are being done than should be done.  All medical literature interprets that it should be done, at a maximum, in 15% of cases, although in many rich countries this figure is being doubled", explains Joaquín Salvador, main author of the study and researcher at PHAB.

The results show that when public healthcare and private healthcare are compared, more caesareans are carried out in the latter case.  "When women from disadvantaged social classes give birth in private clinics, the percentage of caesareans is equal to that of more advantaged classes".

Notwithstanding, the researcher advises prudence when interpreting these results.  "These are two variables that are very difficult to separate.  We cannot deduce that the only thing intervening is the type of maternity either, since logically, women belonging to a more favoured social class are going to have more access to private healthcare", he adds.

Age appears as another factor in these interventions.  According to Salvador's specifications to SINC, "With more age, more caesareans.  And in the same fashion, with more age, more possibilities of enjoying a more accommodated social class, which means there may be older women who go to give birth at private clinics.  But in the study, we confirm that the difference was not so important".

A "comfortable and profitable" practise

For many years, there has been a debate in the world of gynecology and obstetrics concerning the excessive performance of caesareans.  Experts sustain that this surgical intervention should be watched closely, and that it is not risk-free for the mother and the child.

Besides the reasons derived from the complications which may present themselves at childbirth, experts confirm to SINC that there are other non-medical reasons for performing caesareans: the ease that planning childbirth can mean for the doctor, the mother, and the family, as well as the economic factor.  "A caesarean is more expensive than a vaginal childbirth, since it does not just imply a more complex intervention, but more days of hospitalization", concludes Salvador.