Caesarean section—the most common surgery in many countries around the world—is a procedure that can save women’s and babies’ lives when complications occur during pregnancy or birth. However, caesarean section use for non-medically indicated reasons is a cause for concern because the procedure is associated with considerable short-term and long-term effects and health-care costs.
Caesarean section use has increased over the past 30 years in excess of the 10–15% of births considered optimal, and without significant maternal or perinatal benefits. A three-part Lancet Series on Optimising Caesarean Section Use reviews the global epidemiology and disparities in caesarean section use, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary caesarean sections.
Key messages
- CS use is increasing in all regions. In most countries, CS use has reached a frequency well above what is expected on the basis of obstetric indications.
- Inadequate access to CS is still a problem in most low-income and several middle-income countries. The low use of CS implies that women and babies are at much higher risks of dying.
- Optimizing CS use is needed. We need to better understand demand and supply factors that drive the overuse of CS and put more effort into ensuring universal access to CS.
- CS confers an increased risk of maternal mortality and severe acute morbidity and a higher risk for adverse outcomes in subsequent pregnancy compared with vaginal birth. Multiple CSs are associated with a higher risk of maternal morbidity and mortality.
- Infants born by CS have different hormonal, physical, bacterial, and medical exposures and are exposed to more short-term risks compared with those born vaginally.
- Approaches that prioritize positive human relationships, promote respectful and collaborative multidisciplinary teamwork, and address clinicians’ beliefs and attitudes and women’s fear of labor pain and of poor quality of care might reduce CS use.
- Multifaceted strategies are needed to reduce CS use and to increase physiological birth for healthy women and babies; these strategies must be tested, and tailored to local determinants.