WHO target cesarean delivery rate may be `too low`

Washington D.C: Two new studies have challenged the three decades of public-health wisdom, suggesting that the international guideline on the optimal rate of cesarean delivery is too low.

The researchers say raising the World Health Organization's recommended C-section rate beyond the current 10 to 15 percent could result in fewer mother and infant deaths.

The study examined nearly 23 million C-section deliveries that occurred worldwide in 2012. It showed that mother and infant deaths continued to decline as the C-section rate reached 19 percent of births. Only then did mother and infant deaths level off.

"Previously recommended national target rates for cesarean deliveries may be too low," the authors write.

"This 10 to 15 percent target was just kind of created through expert consensus. A lot of things in policy come out this way, but we had some techniques and better data available now than in the past," said Alex B. Haynes from Massachusetts General Hospital in one study.

But the study also shows that the benefits of using the procedure flatten out as the rate exceeds 19 percent. In the United States, where the rate approached one-third of all births in 2013, health officials have called for a reduction in the practice. While rates vary by location, studies have questioned whether C-sections are being used unnecessarily.

"The study of Molina et al highlights the need for an evaluation of cesarean delivery rates by the international obstetrical community," write Mary E. D'Alton, and Mark P. Hehir of the Columbia University College of Physicians and Surgeons in an accompanying editorial.

In another study, Mairead Black, M.R.C.O.G., of the University of Aberdeen, United Kingdom, and colleagues examined the relationship between planned cesarean delivery and offspring health problems or death in childhood.

The findings suggest that avoidance of vaginal birth may be an important early-life factor in the growing global burden of asthma, although absolute increase in risk to individuals is low, the researchers write. "Health professionals and women considering planned cesarean delivery should be made aware of this. However, the magnitude of risk is such that in the presence of a medical indication for cesarean delivery, the apparent risk to offspring health is unlikely to justify a plan for vaginal birth."

The studies are published in JAMA.