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    The controversy surrounding the increasingly high rate of Caesarean sections in Australia and other developed countries tends to focus on the negative maternal outcomes (i.e. the short and long-term complications of open abdominal surgery) and ignores the negative neonatal outcomes which C-sections ameliorate.

    Caesarians have a crucial role to play in the appropriate obstetric management of pregnancies. A certain rate of Caesarian sections leads to reduced maternal and neonatal morbidity and mortality. This rate has been somewhat arbitrarily defined by the WHO as 15%. A recent ecological study showed that increasing rates of Caesarian section in low income countries, where C-section rates are on the whole less than ten percent, are associated with reduced perinatal morbidity and mortality. On the other hand, increasing C-section rates in middle and high income countries show no similar improvements.

    The real question is what level of risk obstetricians and their patients are willing to accept in pregnancy outcomes. Anecdotally, the perceived risks of not proceeding with a C-section greatly outbalance the side effects to the mother and baby of undergoing a C-section. There are clear psychological reasons for this: (1) the many and relatively unknown outcomes of not having a C-section are far more frightening than the few known side effects of surgery; (2) the opportunity to ‘do something’ to actively manage a pregnancy is tempting to both doctor and patient and in itself is anxiolytic.

    Hence, an important reason for the dramatic increase in rates of C-section in Australia may be that the ‘prevented’ unknown adverse outcomes of pregnancy have become far less tolerable to the general public than the known adverse outcomes of a C-section, which due to its prevalence is now a widely acceptable method of managing a pregnancy. This is the converse of the immunisation controversy, where outcomes which are exceedingly rare due to vaccination (e.g. tetanus, measles) are now outbalanced, by perception if not by fact, by the rare side effects of vaccination.

    In the end, obstetricians, and doctors in general, do not practice in a vacuum, but are guided by changing social mores and patient preferences. Any real attempt at reducing the rate of Caesarean section will have to address the attitudes of the public at large.

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    I had a c-section too, and had similar pains. But when I when to see my GP about it, I was told that the pains are unrelated to the c-sect. Thousands of other women have had it too and nonwe have complained. So this may actually be an issue of doctors treating these complains are a trivial issue.


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