The rate of caesarean sections is not the issue

EDITOR—Belizán et al show that the richest countries in Latin America have the highest rates of caesarean section, yet they fail to point out that these countries also have the lowest perinatal, infant, and maternal mortality.1 Using their figures we found a significant negative correlation between rate of caesarean section and each of these (figure) (perinatal mortality r _s =−0.498, p=0.035; infant mortality r _s =−0.506, p=0.032; maternal mortality r _s =−0.903, p=0.001). This does not prove cause and effect, but their claim that 850 000 excess caesarean sections represent an unnecessary increased risk for women and their babies is speculative.

Rates of caesarean section differ hugely within and between countries and reflect numerous variables. To investigate this area properly we must take an impartial view in order to establish the best principles for practice in each situation. To suggest that one caesarean section rate (15%) is optimal for all populations in all countries cannot be sound.2 As found in the United States, the recent drive to reduce the overall rate to 15% is causing problems of its own.3

What matters most is that those women who need a caesarean section get one under optimum conditions and that those who do not need a section get appropriate care and support through labour. Only then will we minimise damage and maximise satisfaction.

Brazilian obstetricians are pressured to perform caesarean sections

EDITOR—I am a Brazilian obstetrician and have worked for more than 10 years as an “on call” obstetrician. During this time, I have been put under pressure to perform caesarean section many times, from patients, husbands, and relatives. Some unjustified fears cause this situation, including the fear of fetal distress during labour, the notion that labour lasting more than six hours is unbearable for the …