C-Section Twin Deliveries in Victoria Tripled in Three Decades
Wed, April 21, 2021

C-Section Twin Deliveries in Victoria Tripled in Three Decades

The rate of twins born by c-section in Victoria, Australia has nearly tripled in three decades, a study published in the Medical Journal of Australia revealed / Photo by: Littlekidmoment via Shutterstock

 

The rate of twins born by c-section in Victoria, Australia has nearly tripled in three decades, a study published in the Medical Journal of Australia revealed.

Cesarean Twin Delivery Rate

In the study titled "Changes in the modes of twin birth in Victoria, 1983–2015", authors Yizhen Liu and colleagues examined the changes in the modes of delivery of twins in the Australian state for more than 33 years. They found out that in 1983, there were only less than a quarter (156) of twin births delivered by cesarean but the rate increased to 71% (782 deliveries) in 2015.

While previous research shows that cesarean delivery is not beneficial for the babies or mothers in twin births and that vaginal birth is preferable, the recent study from Mercy Hospital for Women and the Monash University explained the method of delivery should be “considered carefully” especially if it is an “uncomplicated” twin pregnancy.

Possible C-Section Risks

C-section is one of the most common medical procedures in the world and can be lifesaving for women with complicated births or pregnancies, yet that doesn't mean no risk is involved. In a 2018 study involving Australian mothers and their babies (almost 500,000 births), it was found that cesarean babies had the highest rate of being cold (hypothermia), have metabolic disorders, diabetes, and obesity. Other health complications mentioned were eczema and respiratory infections for babies born in other ways.

In Australia alone, there have been calls to lessen the number of cesarean deliveries as more than one-third of all pregnant women now give birth through cesarean, reported Australian Broadcasting Corporation. It is even double than what the World Health Organization considers as “medically necessary.”

C-section is one of the most common medical procedures in the world and can be lifesaving for women with complicated births or pregnancies, yet that doesn't mean no risk is involved / Photo by: siam.pukkato via Shutterstock

 

What Caused the Increase in Cesarean Delivery?

The cesarean rates continued at a steady pattern of increase, not because of complex pregnancies but because women bear babies later in life, the use of assisted reproductive technology (ART), and higher obesity rates, based on previous studies. The recent study with Liu and the team, however, notes that the increasing cesarean twin delivery rate is caused by twin pregnancy itself.

Melbourne-based healthcare provider Safer Care Victoria’s CEO Euan Wallace, who is also the co-author of the recent study and a professor of obstetrics and gynecology, said that twin pregnancies are more common in older women, women with high body mass index, and those conceiving with assisted reproductive technology. Their obstetricians may suggest cesarean delivery if vaginal birth would be riskier in their case. Wallace added that the vaginal delivery of twins is not less safe compared to a c-section.

Lack of Doctor’s Confidence and Experience in Vaginal Deliveries

The Australian researchers also suggested another factor for the increase in cesarean delivery in the state: there are changes in doctors’ confidence, skills, and training with vaginal twin delivery. Clinicians who have limited experience in delivery would more likely prefer c-section than a natural delivery, they added. “A skilled specialist workforce must be maintained,” the team said.

Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ obstetrician Scott White, who was not involved in the study, commented via ABC Net that the opportunity for obstetric trainees to be more proficient in twin vaginal deliveries has become limited. As the rate of c-section deliveries increase, the rate of vaginal deliveries also goes down. Other doctors would also feel safer to undertake cesarean delivery based on the support and resources available to them. They may further be unlikely criticized for a cesarean, but they may be well criticized if a vaginal delivery goes wrong.

Economic Burden of the Increasing Cesarean Delivery Rate

In a separate study that appeared in the PLOS One journal, Mohammad Rifat Haider and his co-authors said that a high cesarian delivery rate and the negative health outcomes linked with the procedure result in a huge economic burden on families. It leads to the inappropriate allocation of their scarce resources, particularly in a poor economy, such as Bangladesh. They refer to it as “over-medicalizing birth.” The authors said that it is important to control the “unnecessary” cesarean delivery practices by introducing special guidelines and litigation in the country’s health policy.

Cesarean Sections per 1,000 Live Births

The Organization for Economic Co-operation and Development (OECD), an intergovernmental economic organization founded to stimulate economic progress and world trade, has shared the rate of cesarean section delivery per 1,000 live births in 2017. Countries with the highest cesarean rate include Turkey (531), Korea (452), Poland (393), Hungary (373), Italy (338), Switzerland (319), and Ireland (314). Meanwhile, OECD countries with low c-section rates include Israel (148), Norway (160), Iceland (162), Netherlands (162), and Finland (165).

The economic organization emphasized that the benefits of c-section deliveries continue to be debated in different parts of the world. Some claim that it increases maternal mortality, complications for the mother’s subsequent deliveries, and financial cost if not medically required.

It would be appropriate if the healthcare industry can explore other interventions that would safely reduce people’s reliance on c-section delivery, whether on the delivery of twins or not. This most especially applies to pregnant women who opt for c-section for elective reasons, meaning there are no medical reasons that they can’t go into labor.