The United States has seen a steep rise in caesareans to women with no reported medical risk, according to research published today on bmj.com.
Researchers analysed information on four million births per year between 1991 and 2001, identifying mothers with no medical risk or labour and delivery complication noted on the birth certificate. From this group of mothers, they examined those cases where mothers had a first-time caesarean.
Results showed that caesarean rates increased by 67% among these mothers. First-time mothers aged 34 and over were the most likely to have a 'no indicated risk' caesarean, with almost 1 in 5 giving birth by caesarean in 2001.
Caesarean births also rose steeply for 'no indicated risk' mothers under 30, increasing by 58% between 1991 and 2001. For first-time mothers over 40, the odds of having a 'no indicated risk' caesarean were over 5 times that for mothers aged 20-24.
Undergoing caesareans where there is no reported medical indication raises serious questions, say the authors, not least for younger mothers who plan to have further children. More research is needed on whether the risks associated with surgery outweigh the benefits in these circumstances, they conclude.
Professor Eugene Declercq, Maternal and Child Health Department, Boston University School of Public Health, Boston, USA
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