Birth by Appointment: Lack of Effective Pre-natal Guidance Leading to Global Rise in Caesarean Rates

16 April 2017 - Dubai, UAE: Over the last 25 years, there has been a significant increase in caesarean section deliveries globally, creating serious implications on health care and costs. Leading international health benefits and services partner and pioneers in the field of maternity insurance cover, Aetna International calls for more comprehensive education on the impact of caesarean births – not only for the mother but wider society as well.  Aetna International wants to ensure all expectant mothers receive the appropriate medical support – to achieve this governements, health care provides, insurers and NGOs must work together. 

Aetna's latest research report, ‘Striking the right balance: Global caesarean delivery rates in an era of controversy', reveals how the lack of effective pre-natal guidance is impacting global caesarean rates. Factors such as medical liability law and the medical malpractice environment, financial incentives and scheduling convenience have contributed to this global surge in caesarean deliveries. Data from Aetna International's Beginning Right International Maternity Program reveals that in 2015 the rate of caesarean delivery amongst insured members in Dubai, for example, was 25 percent higher than a recent Journal of the American Medical Association (JAMA) article recommended an average of 19 percent. This higher rate of caesarean sections in the region can be attributed to a number of factors including greater levels of obesity and diabetes. 

Caesarean delivery is one of the most commonly performed surgical procedures in the world and while it can save lives, there are also potentially negative impacts on individual health and healthcare resources. The rates for caesarean delivery vary widely by region, ranging from 0.6 percent in South Sudan to 55 percent in Brazil. 

Recent data published in the JAMA suggests 19 percent as the optimal caesarean rate, while the World Health Organisation (WHO) target is considerably lower at 10 to 15 percent. The Aetna research questions if there is such a thing as a universal optimal caesarean rate – and whether it helps achieve greater health equality across the globe. However, Aetna International suggests having a benchmark, such as 19 percent, could be helpful in efforts to ensure women have equal access to appropriate maternity care and technologies in order to strike the right balance between risk and benefits. 

Dr. Lori Stetz, Senior Medical Director at Aetna International says: “Regional differences in caesarean rates highlight a medical imperative – to give expectant mothers consistent guidance on when surgical delivery is necessary. For this reason, Aetna International's Beginning Right International Maternity Program provides expectant mothers with information and counseling on caesarean sections to ensure that any decision is made for the right reasons.

“Women need comprehensive prenatal and maternity support, and that can only be achieved when medical professionals listen to their needs; outline various birth options, and explain the risks and benefits so that the most suitable approach is identified. With this kind of respectful support, women can understand when recommendations are driven by medical necessity and when they are influenced by hospital, practitioner or other cultural factors. 

“This approach is a positive step towards ensuring appropriate caesarean section rates around the world are achieved: it avoids both unnecessary harm to mothers and babies, and lessens the impact on the wider health care community.  As it stands, caesarean births (in the U.S.) cost the health care system two-thirds more than vaginal births and the increased recovery time from the surgery has a greater impact on wider society, for example, social care.

“Countries and health care partners need to look at how to provide high-quality care in all settings and achieve the right proportion of intervention, resulting in healthy mothers and babies. We believe the key to this is working at a local level with the needs of individuals in mind, encouraging the appropriate development of emerging health care systems, and fostering the safe and effective use of medical technology all over the world,” concludes Dr. Stetz.