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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
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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: https://www.atmph.org/text.asp?2015/8/5/224/159844
On a global scale, caesarean section remains one of the most frequent surgeries performed in all settings. , 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.  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%. 
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%.  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. ,
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. , 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. ,,,
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. ,,,
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”.  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. 
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. , 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. ,
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.
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Source of Support: None, Conflict of Interest: None