Caesarean sections increasing in frequency - what influences this?

The number of caesarean sections performed is increasing year on year. The increasing rate of caesarean sections is influenced by a number of factors. The fact that increasingly sophisticated methods of monitoring the foetus during pregnancy and birth make it possible to detect at an early stage even the smallest abnormalities indicating that something is wrong with the foetus or the mother. Thanks to these methods of monitoring pregnancy and birth, rapid intervention in the form of a caesarean section is possible, making it possible to minimise and prevent many of the consequences of the abnormalities that have occurred.

Emergency versus elective Caesarean section

At present, caesarean sections are carried out in hospitals on an emergency or elective basis. Emergency Caesarean sections are performed when any complications arise during pregnancy or childbirth that necessitate the immediate termination of the pregnancy. These abnormalities can occur either on the part of the mother, the foetus or on the part of the placenta or umbilical cord, for example. The most common reason for emergency caesarean section is so-called endangered intrauterine asphyxia of the foetus. The first symptoms of such a threat are an abnormal fetal heart rate. When the baby's heart rate becomes slower and slower, this indicates that not enough oxygen is reaching the foetus. This can be caused, for example, by the umbilical cord becoming encircled, various defects in the umbilical cord, abnormal insertion of the head into the birth canal, ageing of the placenta and an abnormal flow of oxygen through it, as well as many other factors. This can also be caused by poor breathing technique on the part of the mother during labour. Increasingly better and more accurate methods of monitoring the fetal heart rate make it possible to detect such a risk quickly and to decide on an immediate termination of the pregnancy by caesarean section. Lack of progress in labour and a prolonged second period of labour are also indications for an emergency caesarean section. Such a condition may be the result of an abnormal passage of the head through the birth canal or a disproportion between the fetal head and the mother's pelvis. Other very important indications for an emergency caesarean section are various types of haemorrhage, prolapse of the umbilical cord, an increase in the mother's vital signs which may indicate an incipient intrauterine infection, or a significant increase in the mother's blood pressure which may lead to premature detachment of the placenta and consequent fetal demise.

If we are talking about an elective caesarean section, it means that already during the pregnancy a decision has been made to carry out such a termination because it is contraindicated to terminate the pregnancy naturally. In such cases, during a routine check-up, the doctor usually informs the patient of the indications for caesarean section and the risks that may arise, in her case, during natural childbirth. Elective caesarean section is the method of choice. The method chosen is the one that offers less risk to both mother and baby. An indication for a planned caesarean section is, for example, an abnormal bone pelvis of the mother. During a natural birth, there may then be a disproportion between the foetus's head and the mother's pelvis, i.e. a birth incongruity, i.e. the foetus will be too large to pass safely through the birth canal. It is now recognised that a birth weight in excess of 4,000 g may already be an indication for caesarean section.

Other indications for a planned Caesarean section include diseases of the mother (hypertension, severe visual impairment, heart defects), as well as obstetric indications (placenta previa, fetal malposition, multiple births). Nowadays, the pelvic position of the foetus in a primiparous woman, i.e. a woman giving birth to her first child, is an increasingly common indication for cutting. Post-fertility treatment and pregnancies after in vitro fertilisation are also very important indications for cutting. In this case, it is intended to minimise the risk to the child so desired and awaited by the parents. It is also worth mentioning that an indication for caesarean section is increasingly being taken into account in terms of the age of the pregnant woman (particularly for women giving birth for the first time after the age of 35), as well as the wishes of patients who fear for their own safety and that of their baby.

There are many indications for caesarean section and it is impossible to discuss all of them in a few words. With the current advances in medicine, better and better surgical techniques as well as better and safer methods of anaesthesia, the operation can be considered to be of minimal risk and is generally accessible. Nowadays, caesarean sections are performed in every maternity hospital.