Do we practice caesareans too often and without medical reason in France? It is on this controversial subject that specialists in obstetrics debated this weekend at a congress organized by the American Hospital of Paris.
In France, after years of strong growth, the number of caesarean deliveries is relatively stable. According to the latest perinatal survey published by the Ministry of Health, this caesarean rate was estimated in 2016 at 20.4%.
If for most of these births, resorting to surgery rather than vaginal delivery was medically justified, some caesarean sections were performed at the mother’s request. This would concern 1% of caesarean sections performed each year.
It is to these caesarean sections without medical indication that the American Hospital of Paris devoted Friday, December 6 a symposiumthe conclusions of which are relayed by 20 minutes.
Better listen to women
A caesarean section normally consists, when the delivery does not go as planned and it presents a risk for the mother or the child, in a surgical intervention which aims to extract a child from the maternal uterus by incision of the abdominal and uterine wall.
For some women, however, caesarean section is a personal choice. Should we therefore speak of a trivialization of this surgical act, or even of an “epidemic”? No, says Amina Yamgname, head of the maternity department at the American Hospital in Paris, who however sees in their increase a consequence of the #MeToo movement and the debate on gynecological and obstetrical violence. “The caesarean section on request concerns a very small number of patients but opens up a lot of reflections. In particular to understand that childbirth is a real experience, sometimes traumatic and that we need to listen to women differently”, abounds his colleague gynecologist Caroline Geyl.
Indeed, for some women, vaginal delivery is experienced as a trauma: the pain they feel during contractions or the suffering resulting from a tear or an episiotomy lead some multiparas to opt for cesarean section. “comfortable” after a difficult first childbirth.
For Dr Philippe Deruelle, secretary general of the National College of French Gynecologists and Obstetricians (CNGOF), caesareans “on request” are “the meeting between the woman’s request and a complacent gynecologist”. According to him, the fact of programming this intervention also suits the caregivers. “A caesarean lasts about three quarters of an hour, while childbirth can take twelve hours, twenty hours, even more. And when an obstetrician agrees to be the one who will deliver his patient, having a precise date in advance is useful”, he believes.
Better inform women about the risks associated with caesarean section
However, these caesarean section rates, including those performed on the patient’s wishes, vary considerably from one establishment to another. If some maternities manage to maintain a rate of less than 10% of deliveries, others exceed 45%.
But, as the doctors present at the symposium reminded us, a caesarean section is not a trivial act. It is therefore necessary to inform the women who wish it as well as possible of the possible complications and adverse effects, while respecting their expectations. “The newborn will have a greater risk of respiratory distress, because with the contractions, the stress of labor during vaginal delivery will help him adapt to extra-uterine life”, explains Dr Philippe Deruelle . “There is a greater risk of haemorrhage, infection, embolism and thrombosis with this surgery than with vaginal delivery. It also increases the risk factors for subsequent pregnancies of abnormal placenta that can fit into the scar,” adds Dr. Amina Yamgname.
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