Caesarean section

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Selected women

Selected women include those aged between 20 and 34 years, whose baby’s gestational age at birth was between 37 and 41 completed weeks, with a singleton baby in the vertex presentation.

Comparison of ‘selected’ groups of women allows for an indication of standard practice. Selected women, for this indicator, refers to a cohort of mothers who are expected to have reduced labour complications and better birth outcomes. The proportion of selected women is approximately one-third of all women who gave birth in 2016.

Clinical commentary

A caesarean section is an operation in which a baby is born through an incision made through the mother’s abdomen and the uterus (RANZCOG 2016). A caesarean section may be planned (elective) if there is a reason that prevents the baby being born by a vaginal birth, or unplanned (emergency) if complications develop and delivery needs to be hastened.

Caesarean section is one of the most common interventions in pregnancy and is safer now than in the past, however, a small risk of serious morbidity and mortality for both the mother and the baby remains (Betran et al. 2016; Villar et al. 2007; Keag et al. 2018).

The WHO states that, at the population-level caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates (WHO 2015). The caesarean section rate has increased internationally between 2000 and 2015 (OECD 2015). Australia’s caesarean section rate was higher than the OECD average over this time and ranked 26th out of 33 OECD countries in 2015, with a rate of 34 per 100 live births (ranked from lowest to highest) (OECD 2015). The rise in rates of caesarean section may have been influenced by a number of maternal and clinical factors and medico legal concerns, however, the reasons for the steep rise remain unexplained. Besides this general increase in caesarean section, a large variation between countries, regions and hospitals has been documented (Betran et al. 2016; Bragg et al. 2010; Librero et al. 2000). 

Whether the operation is a planned elective procedure or an unplanned emergency procedure, following receiving clear information regarding the benefits of the operation and the short- and long-term risks the woman is able make an informed decision as to whether to proceed with the caesarean section or not.

Indicator specifications and data

Excel source data tables are available from the Data tab.

For more information see Specifications and notes for analysis in the technical notes.

References

Betran A, Ye J, Moller A, Zhang J, Gülmezoglu A & Torloni M 2016. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. Public Library of Science 11(2):e0148343.

Bragg, F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A et al. 2010. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. British Medical Journal, 341:c5065.

Keag O, Norman J & Stock S 2018. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. Public Library of Science: Medicine 15(1):e1002494.

Librero J, Peiro S & Calderon SM 2000. Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals. Journal of Epidemiology and Community Health, 54:631-636.

OECD (Organisation for Economic Co-operation and Development) 2015. Health at a glance 2015: OECD indicators. Paris: OECD Publishing. Viewed 1 August 2017.

RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) 2016. Caesarean section (PDF). Viewed 31 May 2018.

Villar J, Carroli G, Zavalenta N, Donner A, Wojdyla D, Faundes A et al. 2007. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. British Medical Journal, 335:1025.

WHO (World Health Organization) 2015. WHO statement on caesarean section rates. Geneva: WHO.