A minimum C-section rate of 10% is needed for low maternal mortality and stillbirth rates
A recent article on the quality of obstetric care in developed and developing countries demonstrates that childbirth is inherently dangerous and that C-section is the most important lifesaving intervention. This paper suggests that a minimum C-section rate of 10% is required to reduce maternal mortality and stillbirth to low levels. Indeed, the ability to perform C-sections and other high tech interventions like blood transfusions is more likely to lead to low maternal mortality and stillbirth rates than low tech interventions like skilled birth attendants and increased prenatal visits.In Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries in the International Journal of Obstetrics and Gynecology, McClure et al. explore the relationship between maternal mortality and stillbirth rates and the relationship between obstetric care and rates of maternal mortality and stillbirth.
Of the strategies in the emergency obstetric package designed to reduce maternal death, the ability to provide a timely cesarean section is among the most important to prevent a substantial number of maternal deaths and stillbirths. While it is difficult to pinpoint the exact etiology, in developing countries, prolonged labor is frequently the event leading to the maternal death or stillbirth. Associated infections and hemorrhage kill the mother, and fetal infection, asphyxia, and trauma kill the fetus. A timely cesarean section prevents many of the maternal and fetal deaths from infection and hemorrhage as well as fetal deaths from asphyxia. In cases of eclampsia/preeclampsia, a timely cesarean section will also reduce both maternal and fetal mortality.In developing countries, for C-section rates:
<10% an increase of 1% of births by cesarean section leads to a decrease of 116 maternal deaths per 100,000 births
≥10% an increase of 1% of births by cesarean section leads to a decrease of 1 maternal deaths per 100,000 births
<13% an increase of 1% of births by cesarean section leads to a decrease of 1.72 stillbirths per 1000 births
≥13% an increase of 1% of births by cesarean section leads to a decrease of 0.05 stillbirths per 1000 births
The authors conclude:
Although in geographic areas with very high maternal mortality and stillbirth rates, community-based strategies such as training traditional birth attendants may still have a role in reducing both mortality rates, Koblinsky et al have emphasized that no evidence exists that maternal mortality below 100 per 100,000 births can be achieved through community-based strategies without access to emergency obstetric care. Some authors have estimated that to achieve an optimal reduction in maternal mortality, cesarean section rates of 5 to 15% are necessary, with 5% likely being the lowest rate associated with a maximum reduction in maternal mortality. These analyses support the view that significant reductions in maternal mortality and stillbirth may be achieved only through access to emergency obstetrical care, including cesarean section.The clear implication is that maternal mortality rates of more than 100/100,000 births NATURALLY occur in childbirth. So contrary to the claims of homebirth advocates, childbirth is INHERENTLY dangerous. Moreover, C-sections appear to be the most important intervention needed to lower maternal mortality and stillbirth rates to low levels.
Labels: C-section, maternal mortality, neonatal mortality
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