Obstetricians' Opinions of the Optimal Caesarean Rate: A Global Survey

• Published in: PloS one Vol. 11; no. 3; p. e0152779
• Main Authors: Cavallaro, Francesca L, Cresswell, Jenny A, Ronsmans, Carine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.03.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Analysis; Biology and Life Sciences; Cesarean section; Cesarean Section - methods; Cesarean Section - statistics & numerical data; Demographics; Epidemiology; Female; Gynecology; Health facilities; Health insurance; Humans; Hygiene; Infectious diseases; Male; Management; Mathematical analysis; Medical personnel; Medicine; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Obstetrical nursing; Obstetricians; Obstetrics; People and Places; Physicians; Practice; Questionnaires; Research and Analysis Methods; Risk analysis; Risk Factors; Studies; Surgery; Surveys and Questionnaires; Womens health; Young Adult; United Kingdom > UK; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0152779

The debate surrounding the optimal caesarean rate has been ongoing for several decades, with the WHO recommending an "acceptable" rate of 5-15% since 1997, despite a weak evidence base. Global expert opinion from obstetric care providers on the optimal caesarean rate has not been documented. The objective of this study was to examine providers' opinions of the optimal caesarean rate worldwide, among all deliveries and within specific sub-groups of deliveries. A global online survey of medical doctors who had performed at least one caesarean in the last five years was conducted between August 2013 and January 2014. Respondents were asked to report their opinion of the optimal caesarean rate--defined as the caesarean rate that would minimise poor maternal and perinatal outcomes--at the population level and within specific sub-groups of deliveries (including women with demographic and clinical risk factors for caesareans). Median reported optimal rates and corresponding inter-quartile ranges (IQRs) were calculated for the sample, and stratified according to national caesarean rate, institutional caesarean rate, facility level, and respondent characteristics. Responses were collected from 1,057 medical doctors from 96 countries. The median reported optimal caesarean rate was 20% (IQR: 15-30%) for all deliveries. Providers in private for-profit facilities and in facilities with high institutional rates reported optimal rates of 30% or above, while those in Europe, in public facilities and in facilities with low institutional rates reported rates of 15% or less. Reported optimal rates were lowest among low-risk deliveries and highest for Absolute Maternal Indications (AMIs), with wide IQRs observed for most categories other than AMIs. Three-quarters of respondents reported an optimal caesarean rate above the WHO 15% upper threshold. There was substantial variation in responses, highlighting a lack of consensus around which women are in need of a caesarean among obstetric care providers worldwide.