By Asmau Ahmad
The World Health Organisation (WHO) on Friday advised medical practitioners to perform Caesarean Sections (CS) only when medically necessary to reduce some risks of health problems. This is contained in the WHO news release, which highlighted CS as one of the most common surgeries in the world, with rates continuing to rise, particularly in high and middle-income countries. The world health body said: “Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at risk of short and long-term health problems.’’
It said that a new statement from WHO underscored the importance of focusing on the needs of the patient, on a case by case basis, and discouraged the practice of aiming for “target rates’’.
“CS may be necessary when vaginal delivery might pose a risk to the mother or baby, such as prolonged labour, foetal distress, or because the baby is presenting in an abnormal position.
“However, caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.
“Since 1985, the international healthcare community has considered the `ideal rate’ for caesarean sections to be between 10 per cent and 15 per cent.
“New studies reveal that when caesarean section rates rise toward 10 per cent across a population, the number of maternal and newborn deaths decreases.
“But, when the rate goes above 10 per cent, there is no evidence that mortality rates improve.
“The caesarean section rates is based on two studies carried out by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme for Research, Development and Research Training in Human Reproduction.’’
Also, the statement quoted Dr Marleen Temmerman, the Director of WHO’s Department of Reproductive Health and Research, as saying “These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns.
“They also illustrate how important it is to ensure a caesarean section is provided to the women in need and to not just focus on achieving any specific rate.
“Information gathered in a standardised, uniform and reproducible way is critical for healthcare facilities as they seek to optimise the use of CS to assess and improve the quality of care.
“We urge the healthcare community and decision makers to reflect on these conclusions and put them into practice at the earliest opportunity,’’ Temmerman said in the statement.
She said that across a population, the effect of CS rates on maternal and newborn outcomes was stillbirths or morbidities like birth asphyxia which was still unknown.
“More researches on the impact of CS on women’s psychological and social wellbeing is still needed.
“Due to their increased cost, high rates of unnecessary caesarean sections can pull resources away from other services in overloaded and weak health systems.
“The lack of a standardised internationally-accepted classification system to monitor and compare caesarean section rates in a consistent and action-oriented manner is one of the factors that have hindered a better understanding of this trend.
“WHO proposes adopting the Robson’s classification as an internationally applicable caesarean section classification system.”
“The Robson system classifies all women admitted for delivery into one of 10 groups based on characteristics that are easily identifiable, such as number of previous pregnancies or whether the baby comes head first.
“Gestational age, previous uterine scars, number of babies and how labour started are also some of the identifiable characteristics,’’ the statement quoted Temmerman as saying.
