AsianScientist (Aug. 21, 2014) – Efforts must be made to decrease China’s increasing cesarean section rate, suggests a new commentary published in BJOG: An International Journal of Obstetrics and Gynaecology.
China has one of the highest cesarean delivery rates in the world. Of 16 million babies born in 2010, approximately half were by cesarean. Although the exact rate is not known, the current Chinese language literature on cesarean rates in China reports total cesarean rates ranging from 36 to 58 percent. However, before the 1980s, the cesarean rate was below five percent and it did not rise above ten percent until after 1990.
The commentary, offering an analysis into reasons for the increase in cesarean section in the last few decades, concludes that China’s high cesarean section rate appears to be driven by three factors: the structure of the obstetric care system, provider incentives and cultural aspects of patient preference.
A number of factors related to the Chinese obstetric care system and provider factors have been identified as contributors to the rise in cesarean section rates. These include a high overall number of deliveries, financial incentives that promote cesarean delivery over vaginal delivery—including insurance coverage for childbirth, and physician and hospital revenues, and the fact that many physicians’ salaries are supplemented by bonuses on patient volume and collections.
Additionally, patient preferences are an important factor when considering the cesarean section rate in China. The authors note that in the second generation of the One Child Policy, there is a demand for a perfect outcome and both patients and doctors now view cesarean delivery as more effective than harmful. Fear of labour on wards that do not offer pain control, epidurals, nursing support or family support reinforces this expectation, state the authors.
However, current practice may change soon due to the more relaxed One Child Policy introduced in November 2013 and Chinese couples are now encouraged to have a second child. With more repeat cesarean sections, the current risk to benefit ratio will change, conclude the authors.
Susan Hellerstein, Assistant Professor in Obstetrics and Gynaecology, Harvard Medical School, Brigham and Women’s Hospital, and co-author of the study said: “Since the 1990’s China has seen a dramatic increase in cesarean delivery rates from less than 10 percent to over half of women now delivering via cesarean section. This is likely to change in the future and efforts must be made to encourage vaginal delivery by reforming certain aspects of the Chinese obstetric care system.”
“However, it is important to recognize that any efforts to decrease the cesarean section rate must take into account the safety and effectiveness of this delivery method in modern China and preserve maternal and perinatal health.”
The article can be found at: Hellerstein et al. (2014) Is China’s 50% Caesarean Section Delivery Rate Too High?
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Source: Wiley; Photo: MIKI Yoshihito/Flickr/CC.
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