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C-sections: are they overused?

Posted November 13, 2019

Ph.D. student Haylee Fox found that in Queensland, obstetric interventions generally increase with increasing socioeconomic status, rather than medical or lifestyle risk.

“Indigenous mothers, mothers from socio-economically disadvantaged backgrounds, and mothers residing in rural and remote regions attend fewer antenatal appointments, experience higher rates of smoking during pregnancy, are more likely to be obese and have a higher prevalence of pre-existing medical conditions such as hypertension, diabetes and gestational diabetes,” she said.

Mothers who are less likely to need medical intervention during childbirth are more likely to receive it. Image credit: Charles Eugene, Unsplash (Free Unsplash licence)

“These factors are all associated with increased risk during pregnancy and birth, and increase the potential need for obstetric intervention.

“However, my research has found that non-Indigenous, wealthier, urban mothers, who are less likely to be sick and need medical intervention, have the highest rate of all interventions and the lowest rates of vaginal birth.”

Ms. Fox examined patient data from Queensland to analyze obstetric interventions, which included induction of labor, vacuum and forceps delivery, epidural, episiotomy and cesarean sections.

Factors such as increasing average age of first-child, increasing rates of obesity and increasing the use of assisted conception methods such as IVF are often attributed to the rise in cesarean sections in Australia. However, Ms. Fox’s current research suggests this is not the case.

“Preliminary results indicate that in the public sector, these high rates of cesarean sections are being driven by interventions including epidurals and induction of labor, cascading into the need for a cesarean section,” she said. “In the private sector, the high cesarean section rates are being driven primarily by the provision of elective cesarean sections.”

Ms. Fox says these findings suggest a pattern of overuse of interventions, reflecting a global trend in high-income countries.

“The rising rate of obstetric interventions, such as cesarean sections, has been identified both as a national and international concern by maternal healthcare researchers for more than a decade,” she said.

“This concern is due to the increasing rates of morbidity and mortality and the higher costs associated with intervention methods.”

Source: James Cook University

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