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26 March 2012

Curbing C-sections could save billions

Putting a halt to medically unnecessary caesarean sections could save more than R15 billion a year worldwide, a new study estimates.

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Putting a halt to medically unnecessary caesarean sections could save more than R15 billion a year worldwide, a new study estimates.

There is no agreement on what the "correct" C-section rate is. But the World Health Organization has suggested that rates above 15% are probably too high.

The new study found that 69 countries worldwide topped that 15% rate. On the other end of the spectrum, 54 countries had C-section rates lower than 10% - which may be below what is medically needed.

Then the researchers calculated the costs. In countries with high C-section rates, they estimate, getting the figure down to 15% would save R17.5 billion globally each year. By comparison, in countries with low rates, the cost of bringing them up to 10% would be only $432 million, the researchers reported online in the American Journal of Obstetrics and Gynaecology.

Inequities in C-sections

The findings paint a picture of the global inequities in C-sections, according to Drs Jose Belizan and Fernando Althabe, who worked on the study.

One implication is that a better distribution of resources could allow more women in poorer countries to get medically needed C-sections, said Drs Belizan and Althabe, of the Institute of Clinical Effectiveness and Health Policy in Buenos Aires, Argentina.

Recruiting professionals from high-rate countries to perform C-sections in low-rate ones – or to train local health providers to perform them – is one possibility, the researchers said.

Still, putting a dollar figure on the savings from reducing unnecessary C-sections is tricky. One issue is that this study assumed that the correct C-section rate is no higher than 15%. "And that is a very debatable point," said Dr George Macones of Washington University in St. Louis, who chairs the Committee on Obstetric Practice for the American College of Obstetricians and Gynaecologists.

Do caesareans only when indicated

"While cost is one factor to consider," Dr Macones said, "I think that we should be most concerned about doing what is in the best interests of our patients."

Dr Macones said a number a factors have likely driven the rise in the US C-section rate. Some women request the procedure. Some obstetricians may be quicker to do them now out of worry over being sued.

As for how to bring C-section rates to a more appropriate level, he said, "I think the most important is to try to avoid first caesareans, and do them only when indicated." One way to do that, he added, is to do more vaginal deliveries in women who've had a C-section in the past. But many US hospitals do not offer those women the option of a vaginal delivery because they cannot guarantee a team on hand to perform an emergency C-section if necessary.

Also, he advises, limit induction to cases in which it's absolutely necessary.

Obstacles in poor countries

Just how to curb high C-section rates remains the "million dollar question," Dr Belizan and Dr Althabe said.

Dr Macones noted that last year, US officials reported the first dip in the national C-section rate in more than a decade. In 2010, the rate was 32.8%, versus 32.9% the year before. It wasn't a dramatic difference, but experts were hopeful that it pointed to a levelling off.

As for poorer countries, Dr Belizan and Dr Althabe said there are numerous obstacles to women getting needed C-sections. High rates of home birth, too few hospitals and too few providers who can perform the surgery all remain barriers.

(Amy Norton, Reuters Health, March 2012) 

Read more:

76% of all deliveries via C-Section

FAQ: Caesarian section

 
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