Monday, 29 May 2017

Caesarean section as a consumer good

In private medicine in Brazil, the rate of caesarean section has reached 90% of births. In that country, gynaecologists and midwives, if any, have lost the job of helping women to give birth, and some obstetrical clinics only work to schedule and during office hours. Bad research has not helped either. In the year 2000, a team of researchers led by Dr. Mary Hannah revealed that the caesarean section was a safer practice in breech presentations, information that had an almost immediate impact on clinical practice. Four years later it was found that the research had been poorly done and that its conclusions were wrong, but gynaecologists had already lost the skills (not easy) to practice vaginal births for breech babies. The result is that nowadays the breech foetal position is, assumed to be equivalent to caesarean section, despite the lack of evidence that supports the indication.

Due to the continual increase in this practice, The Economist has elaborated a report that emphasizes that caesarean section has become a consumer product linked to economic welfare and the expansion of the middle classes. According to the current data, one in every three children in developed countries are born by caesarean section (one in four in Spain), a figure that only increases with each passing day. But what is more surprising about this indicator is the enormous variability that exists in the comparison between health centres. In the US, the range goes from 7% to 70%, and in Catalonia, according to the data from the Central de Resultados, we know that there is one centre that practices caesarean delivery for two out of three births, bringing its standards closer to those of Brazil.

According to known studies, caesarean section was related to the reduction of maternal mortality up to the figure of 10-15%.  Based on that figure, this surgical practice boomed so that nowadays it adds no value; on the contrary, without providing any benefits, it started to add up to the complications expected in all surgical interventions; for example the specific circumstances related to the caesarean section increase the likelihood of postnatal depression or of carrying babies with placenta previa in subsequent pregnancies.

When clinical professionals allow themselves to be defeated by consumerism and illicit interests, excessive practices, avoidable complications and poor results emerge. The case of caesarean sections is just an example, unfortunately not the only one.

Jordi Varela

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