Cesarean sections are the most commonly performed operations around the world. But just how effective are these procedures, which have their own risks and complications, in saving the lives of women and their newborns?

To help answer that question, researchers at Stanford and Harvard's Ariadne Labs examined C-section delivery rates in 2012 for 194 countries - all the member states of the World Health Organization. In that year, an estimated 22.9 million C-sections were performed in these countries.

The researchers found that maternal and child deaths declined when the C-section rate was up to 19 percent. When the number of C-sections was higher than that, there was no reduction in these mortality rates, the researchers report today in the online issue of the Journal of the American Medical Association.

Those numbers are higher than current WHO guidelines, which recommend that national C-section rates be no greater than 10 to 15 percent of deliveries. Worldwide, the number of C-sections varies widely from region to region, from .6 percent (South Sudan) to 56.6 percent (Brazil). In the United States, the C-section rate is roughly 30 percent.

Stanford surgeon Tom Weiser, MD, MPH, co-lead author, said the study “certainly presents a compelling argument for improved surgical capacity,” particularly in poor countries where there is limited capacity for surgical care. In parts of the developing world, women routinely die of obstructed labor and other pregnancy-related complications because there is no surgical infrastructure and personnel to provide advanced care, including C-section deliveries, he said.

Weiser and his co-authors argue for improving access to these potentially life-saving procedures, which could have many spillover effects, including improved facility infrastructure such as clean water and electricity - both needed for a functioning operating room – as well as improvements in healthcare systems as a whole.

“All the things you need to do to build up surgical capacity, like personnel training, improving supply chains, providing clean water and sterile environments, all contribute to general strengthening of health-care systems,” said Weiser, an assistant professor of surgery. “If you were to build a strong and robust surgical capacity, you’d have a health-care system more resilient and more resistant to catastrophic events, including Ebola or other infectious outbreaks.”

He noted, however, that new surgical services have to be provided within a safe environment to avoid potentially fatal complications, such as infection and bleeding.

“We cannot just advocate for increased access, as services have to be safe and they have to adhere to basic standards of surgical care,” he said.

Previously: Stanford microbiome research offers new clues to the mystery of preterm birth, From womb to world: Stanford Medicine magazine explores new work on having a baby and Study shows women prefer less-intense pain at the cost of a prolonged labor

Photo by Bonbon