The Dominican Republic has the highest rate of C-sections, according to a report released by the World Health Organization (WHO). At 56 percent, the D.R.’s rate his even higher that Brazil’s, where new rules have been forged to fight the “epidemic” of unnecessary cesarean section procedures. Reasons for high C-Section rates range from medical liability to patient vanity. Multiple studies have shown that vaginal births are much less risky that cutting open mothers to deliver their children. The WHO says that only 10 percent to 15 percent of births really need a c-section procedure. Most countries in the Americas are at least double that figure.
C-sections offer a lifeline for complicated births, but are medically unnecessary for the majority of them. The procedure expose both mother and child to increased risks of health complications. Women can suffer from bleeding, infection and infertility. Children born via C-section face an increased risk of breathing complications, asthma and childhood diabetes. Multiple C-sections present additional risks, expert say.
"Having too many caesarean sections is exposing more women to new health problems, like abnormal placentation, which in the case of a second caesarian section can occur in 40% of cases, and in the case of a third caesarian, can occur all the way up to 60% of cases. This represents a risk for maternal death by hemorrhage," said Bremen de Mucio, a regional advisor to the WHO’s Latin American office.
They’re also a burden on the health system. Sixty thousand unnecessary caesareans were performed in Dominican Republic in 2008, according to a previous WHO report, costing $16 million dollars. Rates vary between public and private clinics, with the latter delivering 87 percent of births via C-section. Also like Brazil, unnecessary C-sections appear to be a result of too much care, not too little.
“Meanwhile, the majority of developed countries, including some Latin American nations, have rates lower than 20 percent,” the report said.
For example, Finland’s rate is 16 percent, France’s 18.8 percent, Bolivia’s is 18.6 percent and Panama’s is 18.2 percent. The U.S. delivers about about 30 percent of births via C-section, around the double the recommended rate. Mexico’s rate approaches 50 percent.
"It´s very worrisome that almost four out of every 10 births in [Latin America and the Caribbean] are by C-section," said Suzanne Serruya, director of the Latin American Center for Perinatology, which is part of the WHO. "Doctors, midwives, obstetric nurses, those responsible for health policies, mothers and fathers, and society as a whole should work together to reduce this number and use caesarean sections only when it´s needed for medical reasons."
On Tuesday, Brazilian officials introduced preliminary measure to curb caesareans. First, they require insurance companies to share information with mothers concerning the risks of C-sections. Second, they make hospitals report the C-section rates of individual doctors.
“The epidemic of cesareans we see today in this country is unacceptable and there is no other way to treat it than as a public health problem,” Brazilian Health Minister Arthur Chioro said in a statement. “What’s normal are normal births.”