WHO gives directive on caesarean sections

The World Health Organisation (WHO), says caesarean sections should only be performed when medically necessary.

According the WHO, caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries.

It said although it could save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems.

A statement from the WHO, which was copied to Ghana News Agency on Friday underscored the importance of focusing on the needs of the patient, on a case by case basis, and discouraging the practice of aiming for “target rates”.

It said caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby, for example due to prolonged labour, foetal distress, or because the baby is presenting in an abnormal position.

However, it said caesarean sections could cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.

The statement said since 1985, the international healthcare community had considered the “ideal rate” for caesarean sections to be between 10 per cent and 15 per cent.

It observed that new studies reveal that when caesarean section rates rise towards 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.

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research said.

“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,” Dr Temmerman said.

It said across a population, the effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown.

It noted that more research on the impact of caesarean section on women’s psychological and social well-being is still needed.

The statement said due to the increased cost, high rates of unnecessary caesarean sections could pull resources away from other services in overloaded and weak health systems.

It said 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 had hindered a better understanding of the trend.

“WHO proposes adopting the Robson 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, whether the baby comes head first, gestational age, previous uterine scars, number of babies and how labour started,” it said.

The statement pointed out that using the system would facilitate comparison and analysis of caesarean rates within and between different facilities and across countries and regions.

“Information gathered in a standardised, uniform and reproducible way is critical for health care facilities as they seek to optimise the use of caesarean section and assess and improve the quality of care,” explains Dr Temmerman, adding: “We urge the healthcare community and decision-makers to reflect on these conclusions and put them into practice at the earliest opportunity.”

The WHO Statement on 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.

The programme is the main instrument within the United Nations system for research in human reproduction, working within the Department of Reproductive Health and Research of the WHO.