Reducing Rates of Unnecessary Cesarean Sections in Lebanon

Abstract

Recent years witnessed a dramatic increase in the rate of Cesarean sections (CSs) which reached approximately 44% of total deliveries in Lebanon. This increase is accompanied by an increase in maternal health issues and shortages in the financial schemes for health services.→ CSs may result in serious health consequences and complications for mothers and newborns, if performed unnecessarily.→ If not targeted adequately, unnecessary CSs lead to a significant increase in accidental surgical cuts of internal organs and emergency hysterectomy for mothers and difficulties with respiration, digestion and admission to neonatal intensive care in newborns.→ The determinants behind this increase in Lebanon are the dominance of private sector, the presence of unregulated practice, the use of CSs as a defensive medicine practice, low involvement of midwives in delivery processes, lack of physician accountability and significant misconceptions about CSs among women.→ Evidence- informed recommendations to reduce CSs include:→ Promote individual and community-based awareness in primary healthcare centers, hospitals and private clinics of the adverse consequences of unnecessary CSs and the conditions that necessitate them.→ Provide financial coverage for pain relief during normal birth and increase financial incentives for performing vaginal deliveries.→ Ensure higher involvement of midwives in delivery processes in hospitals, in addition to improving their skills and increasing their payments.→ Apply a policy for a mandatory second opinion along with a post-fact revision and strict audit system and feedback.→ It is recommended to link compliance with these policy and practices with accreditation status of hospitals and primary health care centers.