Letter

Caesarean section controversy

BMJ 2000; 320 doi: 10.1136/bmj.320.7241.1072/a (Published 15 April 2000)
Cite this as: BMJ 2000;320:1072.2

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The rate of caesarean sections is not the issue

  1. Katie Groom, clinical research fellow (katie.groom@ukgateway.net),
  2. Sara Paterson Brown, consultant in obstetrics and gynaecology
  1. Queen Charlotte's Hospital, London W6 0XG
  2. Department of Obstetrics and Gynaecology, Federal University of São Paulo, Brazil
  3. University of New South Wales, Sydney, Australia
  4. Imperial College School of Medicine, Chelsea and Westminster Hospital, London SW10 9NH
  5. Sundaram Medical Foundation, Madras, India
  6. Neonatal Unit, South Cleveland Hospital, Middlesbrough TS4 3BW
  7. Hull Maternity Hospital, Hull HU9 5LX
  8. Latin American Centre for Perinatology, Pan American Health Organization, World Health Organization, Montevideo, Uruguay
  9. Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
  10. Rua Dr Dorio Silva 7, Mata da Praia, Vitoria 29066-100, Espirito Santo, Brazil

    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.

    Relation between infant, perinatal, and maternal mortality and caesarean section rate

    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.

    References

    1. 1.↵
      1. Belizán JM,
      2. Althabe F,
      3. Barros FC,
      4. Alexander S
      . Rates and implications of caesarean sections in Latin America: ecological study [commentaries by E Showalter and A Griffin; A Castro; H Bastian]. BMJ 1999; 319: 1397–1400. (27 November.)
      OpenUrlFREE Full Text
    2. 2.↵
      1. World Health Organization
      . Appropriate technology for birth. Lancet 1985; ii: 436–437.
      OpenUrl
    3. 3.↵
      1. Sachs BP,
      2. Kobelin C,
      3. Castro MA,
      4. Frigoletto F
      . The risks of lowering the cesarean delivery rate. N Engl J Med 1999; 340: 54–57.
      OpenUrlCrossRefMedlineWeb of Science

    Brazilian obstetricians are pressured to perform caesarean sections

    1. Luis G A Quadros, visiting professor (quadros.toco@epm.br)
    1. Queen Charlotte's Hospital, London W6 0XG
    2. Department of Obstetrics and Gynaecology, Federal University of São Paulo, Brazil
    3. University of New South Wales, Sydney, Australia
    4. Imperial College School of Medicine, Chelsea and Westminster Hospital, London SW10 9NH
    5. Sundaram Medical Foundation, Madras, India
    6. Neonatal Unit, South Cleveland Hospital, Middlesbrough TS4 3BW
    7. Hull Maternity Hospital, Hull HU9 5LX
    8. Latin American Centre for Perinatology, Pan American Health Organization, World Health Organization, Montevideo, Uruguay
    9. Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
    10. Rua Dr Dorio Silva 7, Mata da Praia, Vitoria 29066-100, Espirito Santo, Brazil

      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 …

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