SLIDE 1
Elevation of cesarean delivery in Bangladesh: a ten-year follow up study
Shajratul Alam, M Moinuddin Haider, Mizanur Rahman, Nurul Alam, Dr. Quamrun Nahar
1 BACKGROUND
A pregnant women is exposed to many risks that may put both lives of herself and her unborn child into jeopardy. Even if she doesn’t show any sign of complication during pregnancy, the incidences of delivery complications cannot be avoided in some situation. With an aim to saving mother and child in risky cases (for example, when opening of cervix is blocked by placenta
- r when the fetus position is not suitable for safe delivery) [25], physicians resort to cesarean
surgery (CS) - a major operation that involves cutting a mothers abdomen and taking out the child. Beyond such cases that involve medical indication, CS is said to be justified when a mother’s psychological health is involved [20]. CSs are considered safe and, in many situations obvious for life saving [8]. However, they do not carry additional benefit to the mothers who are eligible to have a normal vaginal delivery (NVD), otherwise known as natural births [12]. A mother, going through CS, is prone to greater risk of postpartum complication[2, 24]. She has to spend more days in the hospital and also needs longer recovery days compared to mother with a normal delivery [12]. Repeated CS puts the mother in greater risk of future pregnancy complications [19, 18]. The newborn goes through life threatening situation as well [26, 22]. It takes a large economic toll on patient’s family that accumulates with the charges of operation theatre, hospital lodging, engulfing expensive anti- biotic and drugs for avoiding risk of infection at the incision site etc. These expenses not only put pressure on the family but also on the economy of that country as a whole [21]. Such consequences (both economical and medical), however, couldn’t stall the acceleration
- f CS rate worldwide [1]. Studies, trying to find the reason for such rise, found that – other
than medical emergencies, factors such as mother’s age, parity, obesity [27], previous CS [23],in what type of community the mother lives in [11], choice of caregiver [14] also plays vital role for up-taking of such decision. Mother’s own desire for CS in absence of any medical or clinical complexity also attributes to this rise [5, 13]. A growing concern for avoiding such un-welcomed (both medical and economical) harm has prompted World Health Organization (WHO) to sug- gest that number of CS per 100 births should not exceed 15 regardless of development status
- f any country [15]. While WHO argues that this figure should be considered as a target to be
achieved [3], worldwide 18.6% births are being delivered by CS with rates fluctuating from 6% to 27.2% from least to most developed countries [1]. The percentage of births delivered by CS has been rising sharply in the last 10 years in Bangladesh - it has increased from 4% in 2004 to 23% in 2014 [16]. The scenario becomes worse when we see CS is the procedure of 6 in 10 deliveries in health facilities. It is evident that with the increase of facility delivery, from 12% in 2004 to 37% in 2014 [16], CS rate is also sloping
- upward. While Bangladesh Demographic Health Survey reports give cross-section picture of