S. Chhabra

introduction: Relationship between increasing Caesarean section rates (CSRs), maternal-perinatal outcome continues to be controversial but CSRs, have risen high, regardless of age, babies number etc, higher than necessary for optimal maternal neonatal outcome with geographic variations. WHO advocates that CSRs should remain 5 - 10% and with rates higher than 15%, risks increase. Studies reveal higher perinatal mortality with increasing CSRs. There are many harmful effects on mother too.

objective: To look into status of CSRs, causes of high CSRs, possibilities of reduction in CSRs.

material & methods: Literature search with available search engines was done adding personal experiences and discussions.

results: It was revealed that CSRs are increasing globally. Leading factors quoted are genuine needs, more women asking for CS, liability pressure, continuous electronic fetal monitoring, private care, health problems, race/ethnicity and other characteristics but none accounts for high CSRs. Upward trends in Caesarean births (CBs) are neither explained by maternal characteristics nor pregnancy complications. Babies are more likely to have breathing problems, diabetes, allergies, asthma, exhibit differences in composition of intestinal flora, long-term obesity, immune, endocrine dysfunction independent of intestinal microbiota, prematurity, respiratory distress syndrome, neonatal intensive care unit admission. All these lead to high perinatal mortality. CSs done without medical indication represent drain on resources, negative health equity. Possible interventions to lower CSRs may be partography, vacuum / forceps births, evidence-based protocols for evaluating fetal status, dysfunctional labour, second opinion for CS decision, auditing indications.