WHAT IS C-SECTION DELIVERY?
C-section, or caesarean section/delivery, is a surgical procedure for delivering a baby through an incision made in the mother’s abdomen and uterus. It is a major surgical procedure but is considered safe for women who have medical complications.
REASONS FOR C-SECTION TO BE PERFORMED
• Medical complications such as diabetes, hypertension, infection, and placenta previa (when the placenta completely or partially covers the cervix).
• Fetal distress due to hypoxia or abnormal heart rate.
• Previous C-section to avoid uterine rupture.
• Multiple pregnancies such as twins or triplets.
• Abnormal baby position, such as breech or transverse.
• Prolonged or obstructed labor.
• Failure of labor induction.
• When vaginal birth is not safe for the mother or baby.
WHO RECOMMENDATION FOR C-SECTION
The World Health Organization (WHO) recommends a C-section only when it is medically necessary to avoid unnecessary risks. The optimal C-section rate should ideally be 10–15% at the population level.
C-SECTION RATE IN PAKISTAN
Pakistan is surpassing global recommendations for C-section rates, as shown by its upward trend. Various studies highlight this rise:
• According to a Federal Government Polyclinic Islamabad study, the C-section rate between September 2022 and August 2023 was 53.16%, with 77.89% of cases being emergency C-sections. Previous C-sections were a major contributing factor to the increase.
• According to a tertiary care hospital in Karachi, from January 2020 to July 2021, 54.4% of births were via C-section.
FACTORS BEHIND THE RISE IN EMERGENCY C-SECTIONS
Studies show factors such as younger maternal age, fetal distress, and primigravida (first-time pregnancy). However, the ground reality appears different, with irrational C-section deliveries becoming a trend:
1. Some gynecologists may prefer C-sections to charge higher fees and save time, as a C-section takes about 45 minutes compared to vaginal birth, which may take 1 to 2 days. Many cases are declared emergencies, especially in primigravida women, initiating a cycle of C-sections for future pregnancies.
2. To help control population growth, some hospitals reportedly prefer C-sections, as medical guidelines recommend a 3–4-year gap between pregnancies after a surgical delivery to avoid complications.
3. In urban areas, some patients especially highly educated women request C-sections for convenience.
However, it is inappropriate to overlook the potential medical complications associated with higher C-section rates, which may harm the physical and mental health of both mother and newborn, and have wider social impacts.
DRAWBACKS OF IRRATIONAL C-SECTIONS
Irrational or unnecessary C-sections carry several drawbacks:
• Longer recovery time and hospital stay compared to vaginal birth.
• Higher risk of infection.
• Increased risk of blood clot formation.
• Adhesion and scarring at the incision site, along with more pain after birth.
Beyond these, some prominent risks include:
RISK OF DIABETES
Women who undergo C-sections are more likely to become obese than those who have vaginal births. Obesity itself is a key risk factor for diabetes and other health complications.
Research shows that even after adjusting for body mass index, women who deliver surgically are more prone to diabetes. Altered gut microbes in C-section-delivered babies may increase the risk of insulin resistance, obesity, and diabetes later in life. C-section delivery also raises the risk of developing gestational diabetes in future pregnancies.
GENDER IMBALANCE
Unnecessary C-sections may disturb the natural balance between male and female births. In Pakistan, many families strongly desire baby boys. Since C-sections usually limit women to 4–5 pregnancies, families often stop having children after a son is born to protect the mother from surgical complications. Conversely, families with several daughters and no son may feel pressured to continue trying, but the limited number of pregnancies can cause emotional distress and depression in mothers due to societal pressure.
GUT MICROBIOTA LINK WITH DEPRESSION
Surgical stress allows inflammatory molecules to enter the bloodstream, while antibiotics and hormonal changes can disrupt gut microbiota (dysbiosis). Gut microbes are linked to the brain through the gut–brain axis by producing neurotransmitters such as dopamine, serotonin, and GABA, which regulate mood. Low levels of these neurotransmitters can contribute to depression.
TAKEAWAY
The overuse of C-section deliveries in Pakistan is negatively impacting society. It is increasing the risk of metabolic and autoimmune disorders in women and contributing to emotional distress, especially in cases of societal pressure for a male child. Unnecessary C-sections should be avoided through proper medical guidance, and every decision for surgical delivery especially for a first pregnancy should be carefully evaluated to prevent a cycle of repeated surgeries in future pregnancies.
FAQs
1. Is a C-section safer than vaginal birth?
No. C-sections are safe when medically required but carry higher risks of infection, blood clots, and longer recovery compared to uncomplicated vaginal births.
2. Can a woman have a normal delivery after a C-section?
Yes. VBAC (Vaginal Birth After Cesarean) is possible for many women, depending on the type of uterine incision and overall health.
3. How many C-sections are safe?
Most guidelines recommend limiting to 3–4 C-sections due to increased risk of uterine rupture, placenta accreta, and surgical complications.
4. Does a C-section affect breastfeeding?
Some women experience delayed milk production due to anesthesia or stress, but breastfeeding is still possible with proper support.
5. How can unnecessary C-sections be avoided?
Seek care from trusted healthcare providers, ask for a second opinion, and ensure that any recommendation for surgery is backed by clear medical evidence.
DISCLAIMER
This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider regarding pregnancy and delivery options.
CALL TO ACTION
Unnecessary C-sections can have lifelong effects. Share this article to raise awareness and help families make informed choices. If you are pregnant, discuss delivery options early with your healthcare provider to ensure a safe birth plan.
REFERENCES
1. World Health Organization. WHO Statement on Caesarean Section Rates. 2015.
2. Federal Government Polyclinic Islamabad. Maternal & Child Health Data, 2023.
3. Khan N, et al. “Prevalence of Cesarean Section in a Tertiary Care Hospital of Karachi.” Pak J Med Sci. 2022. 4. Sandall J, et al. “Short-term and long-term effects of caesarean section on the health of women and children.” Lancet. 2018.
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