title: The increasing cesarean rate globally and what we can do about it.
abstract: Cesarean sections sometimes save the lives of mothers and babies; however, they are excessively used compared to medical necessity, which is influenced by various factors that are explored in this article. Since, in most cases the risks of cesarean sections are greater than the benefits, particularly in cesareans that are not medically indicated, it is astonishing that cesarean surgery is the most common surgical procedure, taking away resources from medically necessary care. While economic incentive is counted among the reasons for the increasing cesarean trend, the situation is not so simple since many factors interact to cause the trend. Since reversal of the vaginal birth after cesarean (VBAC) trend downward is correlated with revised policy statements by e.g. American College of Obstetricians and Gynecologists (ACOG), which have since been partially moderated, it became much more difficult for medical institutions to provide VBACs due to concerns about liability. Although whether to give birth by cesarean delivery is a matter for informed consent, yet childbearing women are influenced significantly by their health service providers' opinions. Even though the World Health Organization (WHO) recommends the most peripheral level of maternity care for normal pregnancy and childbirth that is safe using midwives, yet the percentage of midwife deliveries is low. Among other things, it has been suggested that more childbirth by midwife delivery and in out-of-hospital settings can reduce medically unnecessary cesareans and the undue risks associated with them, and free up medical resources for those in need.
authors.affiliation: Institute for Health Economics and Policy, Tokyo, Japan. niino@ihep.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Niino
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics / Q000639:trends*; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008880:Midwifery / Q000191:economics / Q000639:trends; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000191:economics / Q000639:trends; D014944:World Health Organization