A new study in the Canadian Medical Association Journal has found there is a greater risk of maternal death — almost five times more — after a C-section delivery, compared to a vaginal delivery.

The researchers used data on deliveries across Canada (except Quebec) between 2003 and 2015 and found that this risk was greatest among women who were 35 years or older.

The study also found that women who had emergency C-sections during labor (as intended, as a life-saving, not elective, procedure) had better maternal and infant health outcomes than women who planned C-sections in advance.

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The Truth About C‑Section Delivery

These outcomes become graver when looked at from the lens of socio-economic development and gaps in obstetric resources and skills to manage C-section deliveries. According to a recent World Health Organization report, which examined 12 million pregnancies from 1990 to 2017, maternal deaths following C-sections in low- and middle-income countries are 100 times higher than in high-income countries. Even infant deaths after C-sections are much higher, the study notes, with up to a third of all babies dying.

The report elaborates that a quarter of all women who died while giving birth in low- and middle-income countries had undergone C-sections. The first author of the report, Dr. Soha Sobhy, of Queen Mary University of London, said in the WHO report: “In sub-Saharan Africa, one in 100 women who has a Cesarean section will die – 100 times more than women in the UK. The outcomes for their babies are even worse, with 8% not surviving longer than a week.”

Looking into the causes of deaths following a C-section delivery, the WHO report finds that a third of all maternal deaths were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia (when pregnant women develop high blood pressure), 22% to sepsis, and 14% to anesthesia-related causes. This is in accordance with a growing body of research finding C-section deliveries are a primary cause of postpartum hemorrhage.

The exponential increase in the number of C-section deliveries across the world underscores the significance of these new reports. According to a report in The Lancet, in at least 15 countries, 40% of all deliveries happened through a Cesarean section. C-section rates in India have doubled in 10 years, from 8.5% to 17.2% which is twice the global average and much higher than the benchmark of 10-15% set by the WHO.

The WHO guidelines on C-sections mention that for this amount of women and newborns, C-sections can be a life-saving intervention with respect to complications such as bleeding, fetal distress, hypertensive disease, etc. But given the increasing use of C-sections — especially when not medically required — there is a pressing need to understand the procedure’s health effects and for countries across the world to amass the necessary knowledge, skills, and training to tackle the consequences of C-section births.