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Cesarean births (C-sections) are increasing in China. The situation has reached epidemic proportions, and some of the serious consequences should make Chinese women think twice before requesting this procedure. Today, China has one of the highest rates of C-sections in the world, estimated at 46 percent in 2007.

Cesarean delivery on maternal request is a movement that may have started in Brazil, which has one of the world’s largest populations of cesarean-born children. The use of this procedure, however, carries some health risks, warns the World Health Organization, which doesn’t see the advantages of the shift from vaginal birth to cesarean birth.

In a survey of nine Asian nations, the WHO found that unnecessary C-sections are costlier than natural births and raise the risk of complications for the mother. Many experts still insist that natural birth is the ideal way. “The relative safety of the operation leads people to think it is as safe as vaginal birth,” said Dr. A. Metin Gulmezoglu, who co-authored the Asia report, “but that’s unlikely to be the case.”

The WHO, which reviewed nearly 100,000 births across Asia in 2007-2008, found that 27 percent were done by C-section, apparently motivated by mothers’ requests and hospitals eager to make bigger profits. Slightly higher results were reported by the WHO in a study conducted in 2005 in Latin America, which found that 35 percent of the women surveyed delivered their babies by Cesarean section. In Europe, there are big differences among countries. For instance, in Italy the rate is 40 percent, in the Nordic countries it is only 14 percent.

There are several reasons why women in Asia prefer to have their babies by cesarean. Many fear the pain of natural birth or worry that their vagina may be stretched or damaged by a normal delivery. Others believe this procedure is less risky for the mother. And some choose surgery for their delivery after consulting fortune tellers for “lucky” birthdays or time of the day to have the procedure performed.

Hospitals’ drive for profits may also be behind the abuse of C-sections. For example, in China’s larger cities a cesarean can cost up to twice the cost of a natural birth. According to the WHO, 62 percent of hospitals in Asia reported having a financial interest in performing cesarean sections.

In China, abuse of the technique may give rise to problems in health care delivery. For example, C-sections may occupy medical personnel and resources better used elsewhere.

Meanwhile, a study published in Obstetrics and Gynecology found that women who had undergone several C-sections were more likely to have problems with later pregnancies.

According to some experts, China’s introduction of the one-child policy in 1979 may have contributed indirectly to the increase use of this technique. They claim that because the risk is lower when there are fewer repeat C-sections, parents who expect to have only one child may choose what they believe is the safest option. However, very little is known about the safety of C-sections in China. More studies are needed in China on the reasons women may choose cesarean births and an analysis of their consequences on the health of the mother and the child. At the same time, the promotion of midwifery-led maternity care models that emphasize natural birth should be promoted.

Dr. Cesar Chelala is an international public health consultant and the author of “Maternal Health.”

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