Who should decide on caesarean sections?
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《英国医生杂志》
EDITOR—Given the argument against medicalisation of natural processes such as birth and NICE's recent guidance on caesarean section on demand,1 the increasing rate of caesarean deliveries points at its justified use in the name of safety and personal choice (otherwise termed as elective).
In the developing world, however, especially in India, elective caesarean section is yet to become popular and leaves the choice open for obstetric surgeons. In this context, private health care institutions may encourage caesarean deliveries for the prolonged postpartum stay in the hospital. In other words, the profit motive seems stronger than its justified use for maternal safety. My study with Ramanathan found that caesarean delivery is four or more times more likely in private facilities than in the public sector health facilities in India.2 In addition, evaluations of the indications for caesarean delivery often show that the reason cited on records is fetal distress. In such circumstances, should caesarean deliveries be allowed to replace vaginal deliveries and be the necessary tool of safe motherhood in this century?
Udaya Shankar Mishra, Takemi fellow in international health research
Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA umishra@hsph.harvard.edu
Competing interests: None declared.
References
Kmietowicz Z. NICE advises against caesarean section on demand. BMJ 2004;328: 1031. (1 May.)
Mishra US, Ramanathan M. Delivery related complications and determinants of cesarean section rates in India. Health Policy and Planning 2002;17: 90-8.
In the developing world, however, especially in India, elective caesarean section is yet to become popular and leaves the choice open for obstetric surgeons. In this context, private health care institutions may encourage caesarean deliveries for the prolonged postpartum stay in the hospital. In other words, the profit motive seems stronger than its justified use for maternal safety. My study with Ramanathan found that caesarean delivery is four or more times more likely in private facilities than in the public sector health facilities in India.2 In addition, evaluations of the indications for caesarean delivery often show that the reason cited on records is fetal distress. In such circumstances, should caesarean deliveries be allowed to replace vaginal deliveries and be the necessary tool of safe motherhood in this century?
Udaya Shankar Mishra, Takemi fellow in international health research
Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA umishra@hsph.harvard.edu
Competing interests: None declared.
References
Kmietowicz Z. NICE advises against caesarean section on demand. BMJ 2004;328: 1031. (1 May.)
Mishra US, Ramanathan M. Delivery related complications and determinants of cesarean section rates in India. Health Policy and Planning 2002;17: 90-8.