Doubling of C-section rates from year 2000 to 2015 globally was declared an eye-opener on October 13, 2018, in FIGO World Congress. Rapid increase in rates without clear evidence of concomitant decrease in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. This review addresses issues related to exponentially rising rates, reasons for it, and strategies to reduce. Previous cesarean delivery has main contribution to rising rates as per evidence from the literature search in last 5 years. Focus on optimizing indications of primary C-section resulted in making us rethink modifiable indications like labor dystocia, indeterminate fetal heart rate tracing, suspected fetal macrosomia, malposition, risk-adapted obstetrics, litigation fears, on demand cesarean in literate women and overuse of labor induction. Use of uniform classification system (Robson/WHO classification) with recommendations of WHO, FIGO and annual audits with cloud-based anonymous registry will streamline decisions for cesarean in nullipara and help to control the situation.
This is a preview of subscription content, log in to check access.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Boema T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341.CrossRefGoogle Scholar
Gregory KD, Jackson S, Korst L, et al. Caesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29:7–18.CrossRefGoogle Scholar
WHO statement on caesarean section rates. Geneva: World Health Organisation. 2015.Google Scholar
Clark SL, Belfort MA, Dildy GA, et al. Maternal death in the 21st century: causes, prevention, and relationship to caesarean delivery. Am J Obstet Gynecol. 2008;199:36e1–5.CrossRefGoogle Scholar
Editorial. Stemming the global caesarean section epidemic. The Lancet. 2018;392(10155): 1279.CrossRefGoogle Scholar
National Family Health Survey (NFHS-4) 2015-16. International Institute for Population Sciences, Mumbai, India.Google Scholar
Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health. 2018;18:613.CrossRefGoogle Scholar
Jacob KJ, Jayaprakash M, Hibina KP. TMC (Thrissur Medical College) modified Robson criteria for caesarean sections. Int J Reprod Contracept Obstet Gynecol. 2017;6:5038–43.CrossRefGoogle Scholar
Voge JP, Betrán AP, Vindevoghel N, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis on behalf of the WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Lancet. 2015;3(5):e260–70.Google Scholar
Souza JP, Betran AP, Dumont A, et al. A global reference for caesarean section rates (:c-model) a multicountry cross-sectional study. BJOG. 2016;123:427–36.CrossRefGoogle Scholar
Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low- risk planned caesarean delivery versus planned vaginal delivery at term. Maternal Health Study Group of the Canadian Perinatal Surveillance System. CMAJ. 2007;176:455–60.CrossRefGoogle Scholar
Rajbhandary S, Shrivastava VR. Study of Indications and post-operative complications of primary caesarean section in tertiary care hospital in Nepal. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):835–40.CrossRefGoogle Scholar
Bhowmik J, Kyal A, Das I, et al. Pregnancy with previous caesarean section: an overview of adverse of fetomaternal sequelae. Int J Reprod Contracept Obstet Gynecol. 2018;7(5):1817–21.CrossRefGoogle Scholar
Caughey AB, Cahill AG, Guise J-M, et al. Safe prevention of the primary caesarean delivery. Am J Obstet Gynecol. 2014;201(3):179–93.CrossRefGoogle Scholar
Zhang J, Landy H, Branch W, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116:1281–7.CrossRefGoogle Scholar
Spong CY, Berghella V, Wenstrom K, et al. Preventing the first Cesarean delivery; summary of a Joint Eunice Kennedy Shriver National Institute Of Child Health And Human Development, Society For Maternal- Fetal Medicine, and American College Of Obstetrician And Gynecologists Workshop. Obstet Gynecol. 2012;120:1181–93.PubMedPubMedCentralGoogle Scholar
Nelson K, Sartwelle T, Rouse D. Electronic fetal monitoring, cerebral palsy, and caesareans: assumptions versus evidence. BMJ. 2016;355:16405.Google Scholar