Rising Rate of Cesareans Slowing in Industrialized Countries
After decades of steadily climbing cesarean deliveries, the rate of increase is slowing in many industrialized countries, Boston University School of Public Health researchers found.
In a study published online in the journal Birth: Issues in Perinatal Care, researchers counter the belief that rising cesarean delivery rates in industrialized countries are inevitable.
“The general slowing of the rise in cesarean delivery rate suggests that “inevitable” is too strong a description for the current trends and that national cesarean rates may be nearing a plateau,” wrote the authors.
There are multiple reasons why the number of cesarean deliveries have increased in many industrialized countries, leading many to believe that an increase in cesareans is unavoidable, said Eugene Declercq, the study’s lead author and a professor of community health sciences at BUSPH. Clinicians are increasingly comfortable performing cesareans rather than assisting vaginal births, Declerq said, and mothers, while rarely requesting primary cesareans, are more open to surgery. Also, as hospitals perfrm more cesareans, many will set up structures (e.g. 24-hour anesthesia coverage) that facilitate additional surgery.
Declercq and his team compared the cesarean delivery rate trends from 1987 to 2007 in 22 industrialized countries, such as the United States, Spain and Switzerland. They found that from 2003 to 2007, 18 countries experienced a slowing of rate increases, yet the cesarean delivery rate continued to rise.
“It may be that these more modest recent increases are a forerunner of a general leveling in national rates,” the authors wrote. “Alternatively, this slowing in growth might be but a brief pause in a long-term upward trend.”
There is no exact cause for the slowing rate of increase, said Declercq, and more research is necessary. Birth and delivery customs differ between countries, between regions within countries, or and between hospitals. For example, the study notes that cesarean rates in southern Italy are more than twice those in the central and northern regions of the country and recent rates in New Jersey are 50% higher than those in Utah.
While cesarean rates increased in all studied industrialized countries, the authors noted that the pace of increase varied widely across countries. Between 1992 and 2007, five countries more than doubled their cesarean rates while five countries experienced rate increases of 50 percent or less. During that time span, the cesarean rate in Ireland rose from 12 percent to 27 percent but Finland’s rate only increased from 14 percent to 16 percent. In the same period, the cesarean rate in the U.S. increased from 22 percent to 32 percent.
In addition to Declercq, co-authors of the study are Howard Cabral, PhD, MPH, a BUSPH associate professor of biostatistics; Robin Young, PhD, and Jeffrey Ecker, MD.