Caesarean Section: Reasons for and Actions to Prevent Unnecessary Caesareans

According to data from 150 countries, the worldwide caesarean section rate increased from 7% in 1990 to 19% in 2014. Latin America and the Caribbean region reported the highest CS rate 42%, followed by North America 32%, Oceania 31%, Europe 25%, Asia 19%, and Africa 7%. This trend is accompanied by increasing reports of severe adverse outcomes, such as invasive placenta, peripartum hysterectomy, and massive obstetric bleeding. The World Health Organization stated in 2015 that caesareans are effective in saving maternal and infant lives only when they are required for medically indicated reasons and that caesarean rates higher than 10–15% at a population level are not associated with reduced maternal or newborn mortality rates. More than 90% of women claim that they want to give birth in a natural way. In contrast, recent studies suggest that the majority of planned caesareans are carried out for psychosocial or nonmedical reasons. Knowledge about the indications for caesareans is a prerequisite in order to define actions to prevent unnecessary caesareans. The aim of this chapter was to present a review of the history behind, and to evaluate the indications for, caesarean sections in order to suggest appropriate actions to prevent unnecessary caesareans.