PARIS • Worldwide caesarean section use has nearly doubled in two decades and has reached "epidemic" proportions in some countries, doctors warned yesterday, highlighting a huge gap in childbirth care between rich and poor mothers.
The doctors said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing caesarean operations at rates "that have virtually nothing to do with evidence-based medicine".
In 2015, the most recent year for which complete data is available, doctors performed 29.7 million caesarean operations worldwide - 21 per cent of all births.
This was up from 16 million in 2000, or 12 per cent of all births, according to the doctors' research published in The Lancet.
It is estimated that the operation - a vital surgical procedure when complications occur during birth - is necessary 10 per cent to 15 per cent of the time.
But the research found wildly varying country rates of caesarean section use, often according to economic status: In at least 15 countries, more than 40 per cent of births are performed using the practice, often on wealthier women in private facilities.
In Brazil, Egypt and Turkey, more than half of all births are done via caesarean section. The Dominican Republic has the highest rate of any nation, with 58.1 per cent of all babies delivered using the procedure.
But in close to a quarter of nations surveyed, caesarean section use is significantly lower than average. The research authors pointed out that women in low-income situations often lack access to what can be a life-saving procedure.
The study identified an emerging gap between wealthy and poorer regions within the same country. In China, caesarean section rates diverged from 4 per cent to 62 per cent; in India, the range was 7 per cent to 49 per cent.
Dr Jane Sandall, professor of social science and women's health at King's College London and a study author, said there were a variety of reasons for women increasingly opting for surgery.
These include "a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend to a vaginal delivery, as well as medico-legal issues".
Doctors are often tempted to organise caesarean operations to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.
Dr Sandall also said there were often "financial incentives for both doctor and hospital" to perform the procedure.
The study warned that in many settings, young doctors were becoming "experts" in caesarean births while losing confidence in their abilities when it comes to natural births.
Caesarean sections may be marketed by clinics as the "easy" way to give birth, but they are not without risks. Maternal death and disability rates are higher after caesarean births than vaginal births.
The procedure scars the womb, which can lead to bleeding, ectopic pregnancies, as well as stillbirths and premature future births.
The authors suggested better education, more midwifery-led care and improved labour planning as ways of ensuring caesarean sections are performed only when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.
In a comment accompanying the study, Dr Gerard Visser of the University Medical Centre in the Netherlands called the rise in caesarean sections "alarming".
"The medical profession on its own cannot reverse this trend," he said. "Joint actions are urgently needed to stop unnecessary c-sections and enable women and families to be confident of receiving the most appropriate care for their circumstances."