A new study on rates of Caesarean section births worldwide shows use of the procedure has doubled in the past 15 years, according to BBC News, suggesting it has been used more often than is medically necessary. Rates of C-sections rose globally from about 12 percent in 2000, to 21 percent in 2015, the most recent year for which data was available.

C-sections can save lives when certain problems arise during labor. However, it also carries its own risks.

“In particular, C-sections have a more complicated recovery for the mother, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies,” according to Jane Sandall, a social science and women’s health professor at King’s College London, and one of the study’s authors.

The risks are small yet serious, Sandall told BBC News, and increase each time a mother experiences the procedure. But the risks are not limited to the mother.

“There is emerging evidence that babies born via C-section have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health. While the long-term risks of this are not well-researched, the short-term effects include changes in immune development which can increase the risk of allergies and asthma and alter the bacteria in the gut,” Sandall said.

In some countries, over half of childbirths involve a C-section, particularly in Latin America and the Caribbean. The Dominican Republican topped the list with over 58 percent of births using the procedure. Conversely, the study found that in some places such as west and central sub-Saharan Africa, C-sections accounted for just 4 percent of births. In these regions, the procedure is often unavailable even when necessary.

The study urges doctors and women to only opt for the procedure when it is medically necessary. In Brazil where C-section rates had reached 55.5 percent, a measure to reduce C-sections was put in place in 2015.

Though the reasons for unnecessary C-sections vary from country to country, Sandall cited “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.”

In China, there are not enough midwives to fill the demand. In Brazil, doctors may offer the procedure to quickly move mothers through the public healthcare system. Globally, urban areas tend to have more access to C-sections than rural areas.

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