Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations

Non-clinical interventions to reduce unnecessary caesarean sections: new WHO recommendations Newton Opiyo, Carol Kingdon, Olufemi T Oladapo, João Paulo Souza, Joshua P Vogel, Mercedes Bonet, Maurice Bucagu, Anayda Portela, Frances McConville, Soo Downe, Ahmet Metin Gülmezoglu & Ana Pilar Betrán a Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. b School of Community Health and Midwifery, University of Central Lancashire, Preston, England. c Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland. Correspondence to Newton Opiyo (email: opiyon@who.int). (Submitted: 16 May 2019 – Revised version received: 22 August 2019 – Accepted: 23 August 2019 – Published online: 29 November 2019) Caesarean sections can be a lifesaving procedure for mother and baby, but rates beyond 10% at the population level are not associated with reductions in maternal and newborn mortality. The trend towards overuse of caesarean sections is a major concern globally, given the risks to the mother and her child associated with unnecessary caesarean birth. These risks include avoidable maternal complications such as infections, haemorrhage, complications related to use of anaesthesia or blood transfusion, and infant morbidity such as respiratory problems, asthma and obesity in children. Caesarean sections can also lead to added complications for the mother in subsequent pregnancies, such as uterine rupture, placental implantation problems and need for hysterectomy. High rates of caesarean sections are also associated with substantial health-care costs, which can pose a considerable burden on health systems.