Maternal and neonatal effects of caesarean section

Rising rates of caesarean section have stimulated much research and debate in the international medical literature. The proportion of caesarean sections in Australia climbed from 19.4% of all births in 19941 to 29.1% by 2004.2 Already high figures in the United States had risen further to 30.2% by 2005,3 similar to the 33% seen for Latin America in the same year.4 Despite its growing acceptance as an alternative to vaginal birth, caesarean section is not benign surgery. In this week's BMJ, Villar and colleagues add to the growing body of evidence that cautions against high rates of caesarean delivery. The study supports the notion that caesarean section is justified only when benefits outweigh harms.4

The prospective cohort study uses a rich dataset from Latin America, the earlier results of which have been published previously.5 The study clearly shows that high rates of caesarean section do not necessarily produce better health outcomes for mothers and babies. For the 97 095 births studied, severe maternal morbidity was …