How fear of litigation, safety concerns are fuelling caesarean section delivery –Gynaecologists

Lara Adejoro

20 June 2021

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Medical experts say the fear of litigation and patients’ demand are among the major factors influencing the rising incidence of caesarean section in the world.


The experts, President, Society of Gynaecology and Obstetrics of Nigeria, Prof. Oluwarotimi Akinola; and the Chairman, Lagos State chapter of SOGON, Dr. Joseph Akinde said that safety concerns also influence the decision to perform CS, rather than aim for vaginal birth.


According to a new research from the World Health Organisation, CS use continues to rise globally, now accounting for more than 1 in 5 (21 percent) of all childbirths.


This numbe is set to continue increasing over the coming decade, with nearly a third (29 percent) of all births likely to take place by caesarean section by 2030, the WHO research finds.


WHO said worldwide caesarean section rates have risen from around 7 percent in 1990 to 21 percent as of last Wednesday and are projected to continue increasing over this current decade.


WHO recommends the national CS rate to be between 10 and 15 percent with < 10 and > 15 percent representing underuse and overuse of maternal and child health care services, respectively.


The experts say while a caesarean section can be life-saving, it can also be medically unnecessary.



 

Akinola said while the rate of CS is low in Nigeria, it is becoming an epidemic in some countries.


“What we have in Nigeria in most cases is facility-based, so each hospital can only talk about what is happening in their hospital, not what is happening in the society. Overall, our CS rate is probably about 6 percent, if not lesser,” he said.


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Adding, Akinola said if CS use is less than 15 percent, it might be that it is not being offered enough when necessary. “So that is why we still have obstructed labour and prolonged labour in patients who ought to have caesarean section.”


He noted that some patients prefer CS to vaginal birth because of the pains associated with vaginal delivery.


“Sometimes, a patient wants to have c-section done because she doesn’t want to take the risk with normal labour. CS is straightforward, you know the time you want to go in and you know the time you are coming out.


“Sometimes, litigation alone is a factor, such that you want everything to go well; you don’t want to take the risk of long labour. So, it’s enough reason to go for CS, just to be on the safe side.


“And the higher the rate of litigation, the higher the CS rate. Labour is not easy; labour is difficult, so it comes with difficulty sometimes. So you don’t want to take such risk,” Akinola said