Studies Examine Cesarean Delivery Rates, Outcomes

Two studies in the December 1 issue of JAMA examine the relationship between cesarean delivery rates and maternal and infant death, and adverse outcomes in childhood health following planned cesarean delivery at term.
In one study, Alex B. Haynes, M.D., M.P.H., of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, and Thomas G. Weiser, M.D., M.P.H., of the Stanford University Medical Center, Stanford, Calif., and colleagues collected data for 2005 to 2012 for all 194 World Health Organization (WHO) member states to estimate annual cesarean delivery rates. The year of analysis was 2012. Cesarean delivery rates were available for 54 countries for 2012. For the 118 countries for which 2012 data were not available, the 2012 cesarean delivery rate was imputed from other years. For the 22 countries for which no cesarean rate data were available, the rate was imputed from total health expenditure per capita, fertility rate, life expectancy, percent of urban population, and geographic region.
Cesarean delivery is lifesaving for obstructed labor and other emergency obstetrical conditions; however, as a surgical procedure, there are risks of complications and overuse can be harmful to both mothers and newborns. Based on older analyses, the WHO recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize maternal and neonatal (birth to four weeks) outcomes. Studies of the relationship between cesarean delivery rate and mortality have yielded inconsistent results.
In this study, the researchers found that the estimated global number of cesarean deliveries for 2012 was 22.9 million, yielding a global cesarean delivery rate estimate of 19.4 per 100 live births. Analysis indicated that the optimal cesarean delivery rate in relation to maternal and neonatal mortality was approximately 19 cesarean deliveries per 100 live births. Higher cesarean delivery rates were not correlated with maternal or neonatal mortality at a country level. A sensitivity analysis including only 76 countries with the highest-quality cesarean delivery rate information had a similar result; cesarean delivery rates greater than 6.9 to 20.1 per 100 live births were inversely correlated with the maternal mortality ratio. Cesarean delivery rates of 12.6 to 24.0 were inversely correlated with neonatal mortality.
“Previously recommended national target rates for cesarean deliveries may be too low,” the authors write.