According to researchers, most countries are performing C-sections more often than necessary, while elsewhere too many women don't have access to the procedure.

By Renee Cherry
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The rate of C-section births in the U.S. has been a hot topic in recent years, with concern that our doctors are using the procedure when it's medically unnecessary. In the last 15 years, the C-section rate in the U.S. has gone up by 50 percent. And we're not alone; a recent study published in The Lancet suggests that the increase follows a global pattern.

Researchers looked at data from 169 countries that accounted for over 98 percent of all births around the world and estimated that there were 16 million C-sections in 2000. In 2015, their estimates showed that number jumping to 29.7 million-almost twice as many. (Related: 7 Moms Share What It's Really Like to Have a C-Section)

Why the dramatic increase? Several factors, according to the study authors: During that time frame, there was also a 66.5 percent increase in births happening in hospitals combined with a 33.5 percent increase in C-section use in hospitals. Plus, doctors are becoming more and more skilled at C-sections while "losing the wider art of obstetrics and vaginal assisted deliveries," say the authors.

The classic explanation for the high C-section rate in the U.S. is the threat of litigation should something go wrong, says fertility specialist Dan Shapiro, M.D., of Reproductive Biology Associates, part of the Prelude Network. But that argument is harder to make in other parts of the world, which points to convenience as the main reason for the explosion in the rate of C-sections, he says. "C-sections, especially elective ones, are faster than vaginal births and allow care teams to have normal working hours. An obstetrician cannot control his or her schedule very well if he or she is committed to natural birth for his or her patients." (Related: The Rate of Pregnancy-Related Deaths In the U.S. Is Shockingly High)

According to the study authors, a closer look at the numbers reveals that not only are most of the countries' rates too high, but the rate in the remaining countries is too low. In the region with the lowest rate, a part of Africa, only 4.1 percent of births were C-sections. They determined the optimal rate of C-sections is within 10 to 15 percent of births, based on past research looking at C-section use and mortality. (FYI, the U.S. rate was about 31.9 percent in a 2016 CDC report.)

The study authors' main takeaway is that C-section use should be "optimized" globally-by and large, countries are performing C-sections either way too much or not enough. Both extremes can be harmful. In places where the rate is too low, C-sections could be lifesaving for the women who need them. On the other hand, women who don't need a C-section but get one anyway are exposed to unnecessary risks. C-sections are an extremely safe procedure, but complications (while rare) can be serious, says ob-gyn Sherry A. Ross, M.D., author of She-ology: The Definitive Guide to Women's Intimate Health. Period. They include "excessive bleeding, infections of the uterus, incision, or bladder, damage to organs, and adhesions to organs in the pelvis," says Dr. Ross. Reminder: C-sections are major surgery, and the recovery is different for these new moms. (Here's everything you should know about gentle C-sections.)

The results of the study aren't out of left field. A 2016 study published in PLOS One similarly pointed out the wide gap in C-section rates between regions. While both studies have sparked conversation, Dr. Shapiro doesn't see the trend reversing itself. "My best guess is that it would take an effort from an international group-like the World Health Organization-educating patients and doctors about the mortality attributable to C-sections compared to natural birth to close the gap." Until then, just remember to talk over all your birthing options with your doctor to decide what you're most comfortable with, and what's best for you and baby.

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