Background Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. Methods We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). Results According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). Conclusion The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.

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The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014.

Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.

https://www.cell.com/trends/molecular-medicine/pdf/S1471-4914(14)00216-0.pdf

The infant microbiome development: mom matters

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.13451

Quality of care for pregnant women and newborns—the WHO vision

The aim of this bi-monthly column is to highlight Cochrane Systematic Reviews of relevance to pregnancy and childbirth and to stimulate discussion on the relevance and implications of the review for practice. The Cochrane Collaboration is an international organisation that prepares and maintains high quality systematic reviews to help people make well-informed decisions about healthcare and health policy. A systematic review tries to search for, appraise and bring together existing research to answer a specific research quesiton. The Cochrane Database of Systematic Reviews (CDSR) is published monthly online. Residents in countries with a national licence to the Cochrane Libray, including the U.K. and Ireland, can access the Cochrane Library online, free of charge through www.thecochranelibrary.com.

Midwife-led continuity models versus other models of care for childbearing women.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60789-3.pdf

Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care

Poor-quality maternal and newborn care is associated with maternal mortality, stillbirths, and infant deaths and contributes to acute and chronic clinical and psychological morbidity for women who survive. Midwifery care can make an essential contribution to high-quality maternal and newborn

Ngai Fen Cheung

Papers

Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care

Midwifery and Quality Care: Findings From a New Evidence-Informed Framework for Maternal and Newborn Care

Appropriate use of caesarean section globally requires a different approach