To perform or not to perform cesarean section: A controversial decision

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. To perform or not to perform cesarean section: A controversial decision. Ann Trop Med Public Health 2015;8:224-5


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. To perform or not to perform cesarean section: A controversial decision. Ann Trop Med Public Health [serial online] 2015 [cited 2021 Apr 14];8:224-5. Available from:

Dear Sir,

On a global scale, caesarean section remains one of the most frequent surgeries performed in all settings. [1],[2] The recent report suggests that close to 16% of the birth worldwide are performed by caesarean section, with the incidence being more in developed regions. [3] However, this is way beyond the recommendation laid by the World Health Organization (WHO), that no region across the world should have a percentage of caesarean sections more than 10-15%. [4]

Even though, it is a proven fact that if for any nation if the percentage of caesarean sections is around 10%, a definitive reduction in the incidence of both mother and newborn related mortality is being observed, nevertheless, no conclusive benefits have been acknowledged if the caesarean section percentage for any region is more than 10%. [5] It is very crucial to realize that caesarean section can improve the maternal & the neonatal mortality rate, but, it should not be performed if there is no indication, as it can jeopardize the health standards of both women and their babies in short and long term. [6],[7]

From the public health perspective, it is very essential to understand the reason behind the surge in the incidence of caesarean section. Although, many factors have contributed towards it, the most possible explanation would be that it has become a very safe procedure in heterogeneous settings. [1],[2] Not only that, it provides an opportunity for the pregnant female and their relatives to select a lucky day and time for the birth of a child, which is often not possible in a normal delivery, even if labour is induced by the obstetrician. From the mothers’ point of view, by selecting a caesarean section as the preferred mode of delivery, it enables the mother to circumvent the fear of pain and stress attributed to normal vaginal delivery, which is often shown in movies and even always talked upon with the relatives. Also, more often than not the pregnant females can stay assured that their child will not be exposed to birth related complications, especially asphyxia, which is again very much common in cases of normal deliveries. [1],[2],[6],[7]

Not only that, there is a school of thought among some sections of the community that caesarean section offers an added advantage of preserving the pelvic floor (thereby minimizing the chances of urinary incontinence), and even facilitates the prompt return to the sexual life, which is not possible with vaginal deliveries. In addition, owing to the improvement in literacy status, increase in the cost of living, challenges associated with child rearing, and better adoption of family spacing methods, more often than not a large number of couples are often opting for a single child. If that’s the case, the pregnant female and her husband demands for a perfect outcome from the treating obstetrician, and thus most of them go for caesarean section to avoid any legal consequences. However, it will be wrong to not mention that many doctors treat the field of medicine as a source of making money, and hence they often perform caesarean section even if it is not indicated. [1],[2],[6],[7]

Thus, it is high time that both program managers and health professionals should take appropriate measures and work in a concerted manner to reduce the incidence of caesarean sections, and should not focus towards achieving “target rates”. [5] It is not an easy thing to attain, as the main pre-requisite and the biggest challenge is to establish some sort of mechanism to compare the rates of caesarean section and their associated outcomes in a systematic manner, especially in hospital settings. It is quite difficult as a major proportion of hospitals in which deliveries are performed, often not follow any standardized guideline, and hence these cannot be compared neither on the national scale nor on an international scale. Even now, the final decision to opt for caesarean section is based on doctors’ opinion, which is quite controversial, has low reproducibility, and never provides enough evidence to ensure a worthwhile comparison. [5]

Most of these issues can be addressed if all the hospitals worldwide adopt the Robson classification, which can negate all the shortcomings of classification of the indications. [5],[8] This classification enables the segmentation of antenatal women, depending on the five parameters, namely the number of previous caesarean sections; labour onset; gestational age; fetal presentation; and single or multiple births. [8],[9]

In conclusion, it is very important that all the stakeholders should ensure the global adoption of guidelines in order to avoid conduction of unnecessary caesarean sections.



Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: Analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007;21:98-113.
Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al.; World HealthOrganization Global Survey on Maternal and Perinatal Health Research Group. Method of delivery and pregnancy outcomes in Asia: The WHO global survey on maternal and perinatal health 2007-08. Lancet 2010;375:490-9.
World Health Organization. Global Health Observatory Data Repository: Women – Data by WHO region; 2014. Available from: [Last accessed on 2015 Apr 13].
Appropriate technology for birth. Lancet 1985;2:436-7.
World Health Organization. Caesarean sections should only be performed when medically necessary; 2015. Available from: [Last accessed on 2015 Apr 12].
Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al.; World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. BMJ 2007;335:1025.
Gibbons L, Belizan JM, Lauer J, Betran AP, Merialdi M, Althabe F. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed Per Year: Overuse as a Barrier to Universal Coverage. Geneva: WHO Press; 2010. p. 1-9.
Vogel JP, Betrán AP, Gülmezoglu AM. Use of the Robson classification has improved understanding of caesarean section rates in France. BJOG 2015;122:700.
Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu AM, Torloni MR. A systematic review of the Robson classification for caesarean section: What works, doesn′t work and how to improve it. PLoS One 2014;9:e97769.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.159844

Paul Mies has now been involved with test reports and comparing products for a decade. He is a highly sought-after specialist in these areas as well as in general health and nutrition advice. With this expertise and the team behind, they test, compare and report on all sought-after products on the Internet around the topics of health, slimming, beauty and more. The results are ultimately summarized and disclosed to readers.


Please enter your comment!
Please enter your name here