Caesarean section controversy

doi:10.1136/bmj.320.7241.1072/a

BMJ 2000;320:1072 ( 15 April )

Letters

Caesarean section controversy

The rate of caesarean sections is not the issue

Brazilian obstetricians are pressured to perform caesarean sections

Women choose caesarean section

A debate is needed on caesarean section rates in India

Elective caesarean can increase the risk to the fetus

Further research is needed on why rates of caesarean section are increasing

Authors' reply

The caesarean culture of Brazil

The rate of caesarean sections is not the issue

The first 150 words of the full text of this article appear below.

EDITOR $---$ Belizán et al show that the richest countries in Latin America have the highest rates of caesarean section, yet theyfail to point out that these countries also have the lowest perinatal,infant, and maternal mortality.¹ Using their figures we founda significant negative correlation between rate of caesarean sectionand each of these (figure) (perinatal mortality rs= $-$ 0.498,p=0.035; infant mortality rs = $-$ 0.506, p=0.032; maternalmortality rs = $-$ 0.903, p=0.001). This does not prove causeand effect, but their claim that 850 000 excess caesarean sectionsrepresent an unnecessary increased risk for women and their babiesis speculative.

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Rates of caesarean section differ hugely within and between countries and reflect numerous variables. To investigate thisarea properly we must take an impartial view in order to establishthe best principles for practice in each situation. To suggestthat one caesarean section rate (15%) is optimal for . . . [Full text of this article]

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