Editing Caesarean section (section)

==Frequency==
Global rates of caesarean section are increasing.<ref name="Saee2017" /> It doubled from 2003 to 2018 to reach 21%, and is increasing annually by 4%. The trend toward increasing rates is particularly strong in the middle and high-income countries.<ref name=":53">{{Cite book |last=Santos |first=Gonçalo |title=Chinese Village Life Today: Building Families in an Age of Transition |date=2021 |publisher=[[University of Washington Press]] |isbn=978-0-295-74738-5 |location=Seattle |pages=}}</ref>{{Rp|page=101}} In southern Africa, the cesarean rate is less than 5%; while the rate is almost 60% in some parts of Latin America.<ref>{{cite news |title=Stemming the global caesarean section epidemic |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext |access-date=14 November 2018 |work=The Lancet |date=13 October 2018}}</ref> The Canadian rate was 26% in 2005–2006.<ref>{{cite web |url=http://www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d |title=C-section rate in Canada continues upward trend |publisher=Canada.com |date=26 July 2007 |url-status=dead |archive-url=https://web.archive.org/web/20140514183030/http://www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d |archive-date=14 May 2014  }}</ref> Australia has a high caesarean section rate, at 31% in 2007.<ref>{{cite news | url=https://www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html | work=The Sydney Morning Herald | title=To push or not to push? It's a woman's right to decide | date=2 January 2011 | url-status=live | archive-url=https://web.archive.org/web/20110830150304/http://www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html | archive-date=30 August 2011 | df=dmy-all }}</ref> At one time a rate of 10% to 15% was thought to be ideal;<ref name="WHO2015" /> a rate of 19% may result in better outcomes.<ref name="Mol2015" /> The World Health Organization officially withdrew its previous recommendation of a 15% C-section rate in June 2010. Their official statement read, "There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them."<ref>{{cite news | url=https://www.bbc.co.uk/news/10448034 | work=BBC News | title=Should there be a limit on Caesareans? | date=30 June 2010 | url-status=live | archive-url=https://web.archive.org/web/20100720032957/http://www.bbc.co.uk/news/10448034 | archive-date=20 July 2010 | df=dmy-all }}</ref>

More than 50 nations have rates greater than 27%. Another 45 countries have rates of less than 7.5%.<ref name="Mol2015" /> There are efforts to both improve access to and reduce the use of C-sections.<ref name="Mol2015" /> Globally, 1% of all caesarean deliveries are carried out without medical need. Overall, the caesarean section rate was 25.7% for 2004–2008.<ref>{{cite web |url=https://www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/ |title=WHO &#124; Global survey on maternal and perinatal health |access-date=15 July 2017 |url-status=live |archive-url=https://web.archive.org/web/20161110114949/http://www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/ |archive-date=10 November 2016  }}</ref><ref name="Souz2010">{{cite journal | vauthors = Souza JP, Gülmezoglu A, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P | title = Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health | journal = BMC Medicine | volume = 8 | issue = 1 | pages = 71 | date = November 2010 | pmid = 21067593 | pmc = 2993644 | doi = 10.1186/1741-7015-8-71 | doi-access = free }}</ref>

There is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented care.<ref>{{cite journal | vauthors = Hodnett ED | title = Continuity of caregivers for care during pregnancy and childbirth | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000062 | year = 2000 | pmid = 10796108 | doi = 10.1002/14651858.CD000062 | veditors = Hodnett E }}<br />{{cite journal | vauthors = Hodnett ED | title = WITHDRAWN: Continuity of caregivers for care during pregnancy and childbirth | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD000062 | date = October 2008 | volume = 2008 | pmid = 18843605 | doi = 10.1002/14651858.CD000062.pub2 | pmc = 10866098 | veditors = Henderson S }}</ref> More emergency caesareans—about 66%—are performed during the day rather than the night.<ref>{{cite journal | vauthors = Goldstick O, Weissman A, Drugan A | title = The circadian rhythm of "urgent" operative deliveries | journal = The Israel Medical Association Journal | volume = 5 | issue = 8 | pages = 564–566 | date = August 2003 | pmid = 12929294 }}</ref>

The rate has risen to 46% in [[People's Republic of China|China]] and to levels of 25% and above in many Asian, European and Latin American countries.<ref name=msnbc_2010>{{cite web |url=http://www.nbcnews.com/id/34826186 |title=C-section rates around globe at 'epidemic' levels |date=12 January 2010 |publisher=[[Associated Press|AP]] / [[NBC News]] |access-date=21 February 2010 |archive-date=16 March 2013 |archive-url=https://web.archive.org/web/20130316020439/http://www.nbcnews.com/id/34826186 |url-status=dead }}</ref> In Brazil and Iran the caesarean section rate is greater than 40%.<ref name="veconomist" >{{cite news|title=More evidence for a link between Caesarean sections and obesity|url=https://www.economist.com/news/science-and-technology/21730131-bugs-picked-up-birth-are-good-you-more-evidence-link-between|newspaper=[[The Economist]]|date=11 October 2017}}</ref> Brazil has one of the highest caesarean section rates in the world, with rates in the public sector of 35–45%, and 80–90% in the private sector.<ref>{{cite journal | vauthors = Ramires de Jesus G, Ramires de Jesus N, Peixoto-Filho FM, Lobato G | title = Caesarean rates in Brazil: what is involved? | journal = BJOG | volume = 122 | issue = 5 | pages = 606–609 | date = April 2015 | pmid = 25327984 | doi = 10.1111/1471-0528.13119 | s2cid = 43551235 | doi-access =  }}</ref>

===Europe===
Across Europe, there are differences between countries: in Italy, the caesarean section rate is 40%, while in the [[Nordic countries]] it is 14%.<ref>{{cite news | url=https://www.bbc.co.uk/news/health-15840743 | work=BBC News | title=Women can choose Caesarean birth | date=23 November 2011 | url-status=live | archive-url=https://web.archive.org/web/20120819201245/http://www.bbc.co.uk/news/health-15840743 | archive-date=19 August 2012 | df=dmy-all }}</ref> In the United Kingdom, in 2008, the rate was 24%.<ref>{{cite web |url=http://www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on:_caesarean_section.html |title=Focus on: caesarean section—NHS Institute for Innovation and Improvement |publisher=Institute.nhs.uk |date=8 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20111228034801/http://www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on%3A_caesarean_section.html |archive-date=28 December 2011 |access-date=26 May 2012 }}</ref> In Ireland the rate was 26.1% in 2009.<ref>{{cite web |url=http://www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx |title=Caesarean Section Rates Royal College of Physicians of Ireland |publisher=Rcpi.ie |url-status=dead |archive-url=https://web.archive.org/web/20120502072407/http://www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx |archive-date=2 May 2012  }}</ref>

In Italy, the incidence of caesarean sections is particularly high, although it varies from region to region.<ref name="Corriere della Sera">{{cite news|title=La clinica dei record: 9 neonati su 10 nati con il parto cesareo |url=http://www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml |newspaper=[[Corriere della Sera]] |date=14 January 2009 |access-date=5 February 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090724030448/http://www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml |archive-date=24 July 2009 }}</ref> In [[Campania]], 60% of 2008 births reportedly occurred via caesarean sections.<ref>{{cite news |title=Sagliocco denuncia boom di parti cesarei in Campania |url=http://www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html |archive-url=https://archive.today/20130418215746/http://www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html |url-status=dead |archive-date=18 April 2013 |publisher=Pupia.tv |date=31 January 2009 |access-date=5 February 2009}}</ref> In the [[Rome]] region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.<ref>{{cite web |url=http://www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf |title=Tassi di taglio cesareo per istituto ordinati (rango) per valore del tasso 2008. Anno 2008 - III trimestre 2009 (dati provvisori) | trans-title = Cesarean section rates by institution sorted (rank) by rate value 2008. Year 2008 - 3rd quarter 2009 (provisional data) | language = it |access-date=12 August 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110722024230/http://www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf |archive-date=22 July 2011  }}</ref><ref>{{cite news|title=Cesarei, alla Mater Dei il record |url=http://www.tgcom.mediaset.it/cronaca/articoli/articolo438555.shtml |publisher=Tgcom.mediaset.it |date=14 January 2009 |access-date=5 February 2009 }}</ref>

===United States===
In the United States, cesarean deliveries began rising in the 1960s and started becoming routine in the 1960s and 1970s.<ref name=":53" />{{Rp|page=101}}

In the United States, the rate of C-sections is around 33%, varying from 23% to 40% depending on the state.<ref name="ACOG2014" /> One of three women who gave birth in the US delivered by caesarean in 2011. In 2012, close to 23 million C-sections were carried out globally.<ref name="Mol2015" />

With nearly 1.3 million stays, caesarean section was one of the most common procedures performed in U.S. hospitals in 2011. It was the second-most common procedure performed for people ages 18 to 44 years old.<ref>Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. {{cite web |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp |title=Most Frequent Procedures Performed in U.S. Hospitals, 2011 – Statistical Brief #165 |access-date=22 October 2013 |url-status=live |archive-url=https://web.archive.org/web/20131024180807/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp |archive-date=24 October 2013  }}.</ref> Caesarean rates in the U.S. have risen considerably since 1996.<ref name="cdc">{{cite web |url=https://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf |title=Births: Preliminary Data for 2007 |publisher=[[National Center for Health Statistics]] |access-date=23 November 2006 |url-status=live |archive-url=https://web.archive.org/web/20130821102537/http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf |archive-date=21 August 2013  }}</ref> The rate has increased in the United States, to 33% of all births in 2012, up from 21% in 1996.<ref name="ACOG2014" /> In 2010, the caesarean delivery rate was 32.8% of all births (a slight decrease from 2009's high of 32.9% of all births).<ref>{{cite web |url=https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf |title=National Vital Statistics Reports |access-date=9 September 2017 |url-status=live |archive-url=https://web.archive.org/web/20170720102442/https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf |archive-date=20 July 2017}}</ref> A study found that in 2011, women covered by private insurance were 11% more likely to have a caesarean section delivery than those covered by Medicaid.<ref>{{cite journal | vauthors = Moore JE, Witt WP, Elixhauser A | title = Complicating Conditions Associate With Childbirth, by Delivery Method and Payer, 2011. | journal =HCUP Statistical Brief |issue=173 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = April 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb173-Childbirth-Delivery-Complications.jsp | url-status = dead | archive-url = https://web.archive.org/web/20140714142859/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb173-Childbirth-Delivery-Complications.jsp | archive-date = 14 July 2014 | df = dmy-all | access-date = 6 June 2014 }}</ref> The increase in use has not resulted in improved outcomes, resulting in the position that C-sections may be done too frequently.<ref name=ACOG2014/>  It is believed that the high rate of induced deliveries has also led to the high rate of c-sections because they are twice as likely to lead to one.<ref name="npr.org">{{cite web | vauthors = Hensley S |title=C-Sections And The Profit Motive In California |url=https://www.npr.org/sections/health-shots/2010/09/13/129826908/c-sections-and-the-profit-motive |website=NPR |date=13 September 2010 |access-date=November 25, 2022}}</ref>

Hospitals and doctors make more money from C-section births than vaginal deliveries. Economists have calculated that hospitals may make a few thousand dollars more and doctors a few hundred. It has been found that for-profit hospitals do more c-sections than non-profit hospitals.<ref name="npr.org"/> One study looked at the rate of c-sections done for women who were themselves doctors.  It found that there was a 10 percent decrease in the rate of c-sections vs the general population.  But if the hospital paid their doctors a flat salary removing the incentive to do the surgical procedures, which take more time, the rate of c-sections done on women who were themselves physicians exceeded that of the procedure done on non-medically knowledgeable mothers, suggesting that some women who needed c-sections were not getting them.<ref>{{cite web | vauthors = Vedantam S |title=Money May Be Motivating Doctors To Do More C-Sections |url=https://health.wusf.usf.edu/npr-health/2013-08-30/money-may-be-motivating-doctors-to-do-more-c-sections |website=NPR |date=30 August 2013 |access-date=November 25, 2022}}</ref>

Concerned over the rising number of cesarean deliveries and hospital costs, in 2009 [[Minnesota]] introduced a blended payment rate for either vaginal or cesarean uncomplicated births (i.e., a similar payment regardless of delivery mode).  As a result, the prepolicy cesarean rate of 22.8% dropped by 3.24 percentage points. The cost of childbirth hospitalizations in Minnesota dropped by $425.80 at the time the policy was initiated and continued to drop by $95.04 per quarter with no significant effects on maternal morbidity.<ref>{{cite journal | vauthors = Kozhimannil KB, Graves AJ, Ecklund AM, Shah N, Aggarwal R, Snowden JM | title = Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy | journal = Medical Care | volume = 56 | issue = 8 | pages = 658–664 | date = August 2018 | pmid = 29912840 | doi = 10.1097/MLR.0000000000000937 | s2cid = 49305610 }}</ref>

The rise of cesarean births in the United States has coincided with counter-movements emphasizing [[natural childbirth]] with a lesser degree of medical intervention.<ref name=":53" />{{Rp|pages=101–102}}

=== China ===
The rate of cesarean sections began to sharply increase in China in the 1990s.<ref name=":53" />{{Rp|page=101}} This increase was driven by the [[Healthcare in China|expansion of China's modern hospital infrastructure]], and occurred first in urban areas.<ref name=":53" />{{Rp|page=101}} The rise in cesarean deliveries has also resulted in social critique of the medical establishment over the medical necessity of performing cesarean sections.<ref name=":53" />{{Rp|pages=101–102}}