Sky-high Caesarian Section Rates in the World

Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. A statement from the World Health Organization (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates.”Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby – for example due to prolonged labour, foetal distress, or because the baby is stuck in an abnormal position. However, caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.

Ideal rate for caesarean sections

Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10%, there is no evidence that mortality rates improve. There are wide variations in Caesarean section rates across the world, indicating a lack of consensus about the best way of delivering babies.

In countries where cesarean deliveries are currently below 15 percent, there is an improvement in infant, neonatal and maternal mortality and low birth rate with increases in the cesarean rate. In countries where cesarean deliveries are greater than 15 percent, the increasing rates are not associated with these health improvements and can be associated with harm. In middle and higher income countries, substantial decreases in health risks and costs can be achieved through reduction of unnecessary cesarean deliveries.

Countries with the highest CS Rates in each Region:
1). Brazil (55.6%) and Dominican Republic (56.4%) in Latin America and the Caribbean
2). Egypt (51.8%) in Africa,
3). Iran and Turkey in Asia (47.9% and 47.5%, respectively),
4). Italy (38.1%) in Europe, 
5). United States (32.8%) in Northern America,
6). New Zealand (33.4%) in Oceania. 

In Egypt, according to the latest data, more than half of all women give birth by CS without much difference between urban and rural areas. In China, choosing the date of the baby’s delivery on the basis of luck and fate for the future of the baby by some people is one of the explanations for scheduling a CS. On the other hand, several European countries have managed to control their CS rates over time. It is noteworthy that Finland has one of the lowest increases not only in Europe but among all countries included in this analysis.Japan (19.8 per cent) among the lowest in Asia.

Around one in four births in the UK is by c/s, while in Cyrus the figure is 52% and in Sweden 17%. The United States has a very high rate of cesarean delivery, one in three births happen by c/s, or 1.3 million babies born via surgery (32.8%). A study in France found more cesarean sections were performed in for-profit hospitals than in public hospitals, which treat more complicated pregnancies, suggesting that financial incentives may also play a role in explaining excess cesarean deliveries.

Betrán, A. P, Ye, J., Moller, A-B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE,11(2):e0148343. doi:10.1371/journal.pone.0148343. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148343

Health at a Glance:  OECD INDICATORS. (2013). Retrieved from website:http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf

Nitrous Oxide

Nitrous oxide (N2O) is routinely used as an analgesic in obstetrics during labour. Nitrous oxide is known by most people as “laughing gas.”Many dentists use it to help with pain during dental care. Nitrous oxide was discovered by the English scientist and clergyman Joseph Priestley in 1772, when he noticed that a candle burned in the air with a remarkably vigorous flame. That was one year after the discovery of oxygen. In 1800 Humphrey Davy of the Pneumatic Institute in Bristol, England, experimented with the physiological properties of the gas, such as its effects upon respiration. He even administered the gas to visitors to the institute, and after watching the amusing effects on people, who inhaled it, coined the term "laughing gas." The date that Davy's experiment with nitrous oxide was on Boxing Day, December 26, 1799. On this day, Davy locked himself into a box and had a physician release 20 quarts of N2O into the box every 5 minutes for as long as he remained conscious. He lasted more than an hour in the box, and happily survived the ordeal.

He described his experience this way:

·         He noticed a sweet taste in his mouth, and a gentle pressure in the head, chest and limbs which spread to his fingers and toes.

·         He experienced vision changes and objects becoming clearer and brighter.

·         His hearing became acute while a distant but not unpleasant.

·         He said that the previously cramped box suddenly felt larger and more spacious.

·         He enjoyed himself immensely and declared the entire experiment a huge success.

Nitrous oxide remained a novelty until 1844, when Horace Wells had one of his teeth extracted while breathing the “laughing gas.’ In 1868, Andrews advocated the addition of oxygen with nitrous oxide to prevent the hypoxia often associated with its administration, thus permitting gaseous anesthesia with a nitrous oxide-oxygen mixture to become a reality. In 1881, Stanislav Klikovich in Russia introduced the use of nitrous oxide in the treatment of angina pectoris. He was the first physician to make a detailed study of nitrous oxide oxygen mixtures to provide pain relief without loss of consciousness or hypoxia. In 1934, Minnitt was the first to introduce a self-administered apparatus containing nitrous oxide and air for analgesia during childbirth.

Nitrous Oxide and the Brain

Technically nitrous oxide is not a narcotic because it is not processed through the liver. It is however classified as an analgesic because it relieves pain by releasing opioids while simultaneously activating your opioid receptors. It is classified as an anesthetic in its own right although lighter doses are used as an aid to a general anesthetic in applications as an anxiolytic, meaning that it is known to reduce anxiety

Labour and Childbirth

 For labor pain, half nitrous oxide gas is mixed with half oxygen and breathed through a mask or a mouthpiece. Labour is usually painful, yet, each woman’s experience of labor pain is highly individual with respect to both the nature and intensity of the sensations and her ability to cope. Exceptionally, a very few women may not feel pain; others can control their response so as to reduce pain. Most women think that pain is going to be a major part of giving birth. Some women experience a high degree of physical pain without suffering; others suffer greatly from pain that caregivers think is modest.

Many women in Europe and other countries, such as Canada, South Africa, United Kingdom, and Australia, use it to help cope with pain in labor. It is so common that in some countries as many as 8 in 10 women use nitrous oxide to help with labor pain. Women in these countries have been using this method of pain relief in labor safely for many years. Nitrous oxide hasn’t been used as often in the United States, but that is changing. The inhalation administration of nitrous oxide to women during labor could be an alternative to the common interventions used. Many women use nitrous oxide while standing, squatting, sitting in chair, birthing ball or in shower

The full analgesic effect of nitrous oxide is felt 50 seconds after inhalation. A person might feel drowsy, lightheaded, or a little silly while using nitrous oxide. This is why it got the name laughing gas. The dizziness means it is working well and the person should be encouraged to sleep after a contraction. The relaxation helps to speed the labour process. It is failry simple and easy to use. The nitrous oxide mask or mouthpiece is always held by the labouring woman by breathing the gas.

Nitrous Oxide is Safe for Baby

Nitrous oxide is a very safe for babies. Experts dont believe that using N2O presents any dangers to mother and baby because unlike a narcotic, Nitrous oxide is the only pain relief method cleared from your body through your lungs rather than the liver and expelled completely and no evidence of adverse effects to baby. As soon as the mask is pulled away, the effect of breathing the gas is gone within a few breaths. No extra monitoring is needed for mother or baby because of using nitrous oxide. Although metabolized in the lung tissue although some of the gas passes into the blood stream. However, studies have not shown adverse effects on babies of mothers who used nitrous oxide in labour.

Quick Recovery 

There are no long lasting effects when using nitrous oxide, you breathe into the mask, which you hold and control, when you need it for the pain. When the labor pain subsides, pull the mask away from your face, take a couple of breaths and the nitrous oxide is out of your system quickly. It has been reported that the Duchess Kate Middleton used nitrous oxide during labour and from what I see is that she seems to be walking around with all her mental faculties as well as the rest of us

Source

Agency for Healthcare Research and Quality. (2012). Nitrous Oxide for the management of labor pain. Retrieved from website:

http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1230&pageaction=displayproduct

Public Domain Essays: http://publicdomainreview.org/2014/08/06/o-excellent-air-bag-humphry-davy-and-nitrous-oxide/

 McAney, T. M., & Doughty, A. G. (1963). Self-administered nitrous-oxide/oxygen analgesia in obstetrics.  Anesthesia, 18(4). Retrieved from website: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1963.tb13573.x/pdf