Cesarean Section: Untimely Operations

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Table of Contents

Introduction
Background
Too Much Too Soon
Too Little Too Late
Conclusion
References

Introduction

Maternity care is one of the priorities of healthcare systems of many countries irrespective of their income and standards, which translated into certain improvements although many issues still persist. As far as positive shifts in this area, the global birth coverage involving skilled healthcare professionals reached 74% (compared to 57% in the 1990s) (Campbell et al., 2016). However, this progress is far from being reassuring since only some countries see improvements while others display alarming results.

For instance, maternal mortality ratios went up in twelve countries including the United States (Koblinsky et al., 2016). It has also been estimated that annually, 289,000 women die during pregnancy, child labor, or after it (Renfrew et al., 2014). The provision of, the so-called, too little too late (TLTL) and too much too soon (TMTS) care is seen as one of the factors contributing to high mortality rates and poor health outcomes for mothers and children. Cesarean section is one of the brightest illustrations of this kind of practice as thousands of women and children die due to an untimely operation or have to face adverse health issues after the delivery.

Background

Until the 19th century, the cesarean section was the only alternative to saving the baby’s life. Closer to the 19th century, the uterus was simply amputated to prevent bleeding and postpartum complications (Campbell et al., 2016). Later, doctors began to suture a three-layer seam, so it became possible to save not only the child but sometimes the mother. However, the percentage of maternal mortality after surgery was still high: 20-25% (Dempsey, Diamond, Bonney, & Myers, 2017).

In the 20th century, with the invention of antibiotics and antiseptics, maternal and child deaths in the cesarean section became quite rare. Dempsey et al. (2017) note that the list of indications for the procedure can hardly be exhaustive, but the most common medical reasons for the surgery include repeat cesarean section, failure to progress in labor, possible fetal distress, and others.

Too Much Too Soon

With the increase in the birth rate in high-income countries (HICs) and the development of technology to create medical equipment, many women and even specialists began to prefer cesarean sections rather than vaginal delivery. One of the most pronounced negative outcomes related to the overuse of the surgical method is related to resource distribution, which is a burning issue in low-income countries (LICs) (Betrán et al., 2018). In simple terms, wealthier females request a cesarean section, which exhausts limited resources of healthcare facilities and deprives underprivileged women of receiving this type of care even if it is a medical necessity.

However, the surgery is associated with quite numerous complications such as infection, thromboembolism, hemorrhage, surgical injury, pain, asthma, adhesion formation, failure to breastfeed, infertility, or even maternal or neonatal death (Dempsey et al., 2017). Mothers who had cesarean sections do not have immediate contact with their child, which has a negative effect on both mother and child. Dempsey et al. (2017) also note that females who underwent surgery displayed lower levels of satisfaction compared to those who had a vaginal delivery.

Too Little Too Late

However, the apparent simplicity of this operation does not mean that childbirth becomes less dangerous. In low-income countries, a very small percentage of physicians practice the cesarean section, and mortality after it is much higher than without surgery (Dempsey et al., 2017). Miller et al. (2016) insist that the surgical method can be used only if the woman in labor has health problems and the cesarean section is the only way for her to give birth.

The underuse of the surgery is associated with serious health issues that can lead to a mother’s death (Dempsey et al., 2017). These health conditions include high blood pressure, infection, obstructed labor, and hemorrhage. In many cases, mothers die because of blood loss or exhaustion due to obstructed labor. Cesarean section underuse often leads to neonatal injuries as children can be injured due to the lack of qualified personnel and appropriate equipment. The leading causes of the failure to implement the procedure in a timely manner are the inability to diagnose indications, the lack of resources, and insufficient access, especially in rural areas.

Conclusion

To sum up, it is necessary to state that the cesarean section is associated with TLTL and TMTS care that results in thousands of deaths, adverse health outcomes, and financial losses due to the choice of a cost-ineffective practice. Although there is no compelling evidence that this method of delivery is better for women and children, many people prefer surgery. At the same time, thousands of females who have medical indications to undergo the operation have no access to this healthcare service due to economic and social issues.

The underuse of the surgery is often associated with maternal or neonatal death, while overuse of this procedure is characterized by adverse health outcomes and inadequate resource distribution. It is clear that the problem needs careful consideration, and some interventions should be introduced in order to eliminate or diminish the disparity and make the use of the cesarean section justified and accessible.

References

Betrán, A. P., Temmerman, M., Kingdon, C., Mohiddin, A., Opiyo, N., Torloni, M. R., … Downe, S. (2018). Interventions to reduce unnecessary caesarean sections in healthy women and babies. The Lancet, 392(10155), 1358-1368.

Campbell, O. M., Calvert, C., Testa, A., Strehlow, M., Benova, L., Keyes, E.,… Bailey, P. (2016). The scale, scope, coverage, and capability of childbirth care. The Lancet, 388(10056), 2193-2208.

Dempsey, A., Diamond K. A., Bonney E. A., & Myers J. E. (2017). Caesarean section: Techniques and complications. Obstetrics, Gynaecology & Reproductive Medicine, 27(2), 37-43.

Koblinsky, M., Moyer, C. A., Calvert, C., Campbell, J., Campbell, O. M., Feigl, A. B., … Langer A. (2016). Quality maternity care for every woman, everywhere: A call to action. The Lancet, 388(10057), 2307-2320.

Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., … Althabe, F. (2016). Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. The Lancet, 388(10056), 2176-2192.

Renfrew, M. J., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., … Declercq, E. (2014). Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129-1145.

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