eMagazine June 2023

OUR PEOPLE,
OUR MISSION
Global Health
eMagazine
June 2023
Women’s Health Education
Section Editor: Sarah Cordisco, RN
Staff Nurse at the University of Vermont
Cesarean Sections
Written by Sarah Cordisco, RN
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Across the globe, the maternal mortality rate is decreasing, yet remains extremely high. In
2020, about 287,000 women died during and after pregnancy and childbirth (WHO), most of
which could have been prevented. An analysis published in The Lancet, found that maternal
deaths in LMIC are 100x higher than those in high income countries, and a 1/3rd of all babies
in some regions do not survive cesarean section. The use of cesarean sections has continued
to rise globally and now they account for more than 1 in 5 childbirths (or 21% of all births). By
2030, this number is expected to reach nearly a third or 29% of all births (WHO, 2021). In LMIC
countries, about 8% of women give birth via cesarean section, which indicates a lack of access
to this type of surgery compared to MHIC countries where rates are as high as 43% of all births.
Maternal death rates may be high in LMIC where the cesarean section rate is low due to lack of
access to resources and care, and lack of surgical intervention in a timely manner.
Cesarean sections are often lifesaving procedures when vaginal delivery would pose great
risks, but it is important that health care systems are doing these operations appropriately and
safely with the proper post-op care; as well as, having the proper indications for this procedure.
Cesarean sections are typically indicated during labor dystocia, abnormal or intermediate fetal
heart rate tracing, fetal malpresentation, multiple gestation or suspected fetal macrosomia
(Safe Prevention of the Primary Cesarean Delivery, 2014.). Some women may also choose to
have a cesarean section due to their own medical history (such as thrombocytopenia), having
previous traumatic births, or in cases where a vaginal birth is unwanted.
While this procedure may be elective or emergent, it is important for women to understand
the risks and benefits, as well as, the outcomes, specifically in the realm of maternal and
natal deaths. In LMIC the risk of death while undergoing a cesarean section was 7.6 per 1000
procedures, the highest burden being in Sub-Saharan Africa. The overall rate of stillbirths in
babies born via C-section was about 56 per 1000, with the highest rates in sub-Saharan African
(82.5/1000). The risk of infant death (stillbirths
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or deaths within the first week of life) is about 84 per 1000 C-sections, with the highest rates
in the Middle East and North Africa (Study, 2019). Women undergoing emergency C-sections
are also twice as likely to die compared to those who had elected to have a C-section, and
this risk increased 12x when the surgery was performed during the second stage of labor.
Similarly, the risk of neonatal deaths increased 5x with emergency C-sections compared to
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