The use by caesarean doctors to give babies has almost doubled in 15 years to reach "alarming" proportions in some countries, a study says.
The rates rose from approximately 16 million births (12%) in 2000 to an estimated 29.7 million (21%) in 2015, according to the report in the medical journal The Lancet.
The nation with the highest percentage for using the operation to assist in childbirth is the Dominican Republic with 58.1%.
Doctors say that in many cases the use of the medical procedure is not justified.
Until recently, the World Health Organization (WHO) suggested that a caesarean (or C section) of more than 15% was excessive.
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The study analyzed data from 169 countries with statistics from 2015 – the most recent year for which the information is available.
What does the study say?
It says there is an excessive dependence on cesarean procedures – when surgery is used to help with a difficult birth – in more than half of the nations of the world.
Researchers reported a percentage of more than 50% in the Dominican Republic, Brazil, Egypt and Turkey, although in 2015 Brazil adopted a policy to reduce the number of caesarean sections among doctors.
They also found enormous differences in the use of technology between rich and poor countries. In some circumstances, especially in sub-Saharan Africa, the operation is not available when it is really needed.
Use in 2015 was up to 10 times more frequent in Latin America and the Caribbean, in 44% of births, than in the west and central Africa, where it was used in only 4% of cases.
The study encourages health care professionals, women and their families to choose caesarean sections only when needed for medical reasons – and to provide more education and training to dispel some concerns about childbirth.
What are the risks?
Caesarean section can be a lifesaving procedure for both mother and child, for example if a baby is in an uncomfortable position in the womb or if the delivery does not proceed as it should.
Jane Sandall, professor of social sciences and women's health at King's College in London and author of one of the studies, told the BBC that the risk for mothers and babies can be both short-term and long-term .
"C-sections in particular have a more complicated recovery for the mother and lead to scarring in the womb, which is associated with bleeding, abnormal placental development, ectopic pregnancy, stillbirth and premature birth in subsequent pregnancies."
Prof Sandall says it is important to note that these are small but serious risks, but each of these risks increases with each time a woman undergoes the operation.
"There are indications that babies born through a C-section have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health, although the long-term risks of this have not been well researched, is the short term effects include changes in the development of the immune system that can increase the risk of allergies and asthma and can change the bacteria in the gut. "
"There is the risk associated with any kind of surgery," said Prof. Sandall, adding that multiple cesarean procedures lead to a higher risk of maternal mortality compared to a natural delivery.
Earlier this week the WHO published guidelines with the need to reduce unnecessary procedures that "can not be medically justified".
"It is crucial that women who need cesarean sections have access to this potentially life-saving procedure," advises the WHO, adding that it is equally important to avoid unnecessary procedures, so that women and their babies are not endangered. ".
Why is surgery performed unnecessarily?
Prof Sandall says that the reasons vary from country to country and that with the poorer countries the choices are extremely limited.
"Globally, drivers vary for rising rates from country to country and there are shortages of midwives to prevent and detect problems, lose medical skills to participate confidently and competently [potentially difficult] vaginal delivery, as well as medical-legal issues. "
She adds that financial incentives exist for both doctor and hospital with the certainty of scheduled deliveries during the day, especially in private practices.
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"In some cases, the trend is system-driven: in Brazil, for example, the free public healthcare system is of lower quality and pregnant mothers who can not afford private health care can be given the procedure to help patients get through the system faster."
"In China, a shortage of midwives can result in a lack of screening, meaning that not only necessary medical checks are performed, but that there is a lack of expert help in assisting childbirth."
There is a variation within countries between the rich urban delivery in private facilities where there is a high Caesarean section and the poor in rural areas without access to the procedure, says Prof Sandall.
What can be done to improve things?
"The problem for women is how do you plan?" Prof Sandall says.
"Suspicion that mothers blame for the high caesarean section, or because of their poor health – eg overweight, high blood pressure – or because they need medically unnecessary caesarean sections because of fear or disinterest in labor, the wider system issues that cause growth are relying on cesarean sections. .
"Pregnant mothers must have access to professional and informed advice to make a decision."
She adds that the focus now needs to be on providing more frontline staff at facilities in countries where the problem is the greatest concern.
"We need to work with insurance companies in these countries to help deliver services and staff, and with local and national governments to invest in healthcare."
Campaigners say that some women who apply for an elective Caesarean section sometimes "take a condemnation". They claim that some expectant mothers who ask for the procedure may be survivors of sexual abuse or suffer from poor physical or mental health.
What is a caesarean section?
A caesarean section is when a baby is delivered by making a surgical cut in the abdomen and uterus.
They fall into three categories:
- elective – at the request of the mother and sometimes for non-medical reasons
- planned – usually for medical reasons, such as that the baby is in the wrong position or is very large
- emergency – usually due to complications during delivery
Recovery after a Caesarean section usually takes longer than with a natural birth. The wound eventually forms a scar.