Rising trends and changed indications of caesarean sections in Sikkim, India: cause for concern?

Background: Caesarean sections (CS) are performed when vaginal delivery is found unsafe for the fetus and/ or mother. CS may be associated with many short and long term complications. World health organization determines that CS rate should within five and fifteen percent and no additional benefit is gained to the neonates or mothers when the rate exceeds the highest level. The rate of CS is above the WHO determined mark for many developed and developing Asian countries, and it is increasing over the time. This situation of overburdened caesarean rates needs special attention. The scenario of the states with respect to the CS and the complications that are responsible for the caesarean section is a matter that has to be given some insight into. The aim of this study was to investigate and compare the rate and indications for CS in the early 2000s as compared to early 2010s.Methods: It was a retrospective cohort study. Data were collected from original obstetrical records in different hospitals of Sikkim in 2001 and 2011. Both groups were compared for CS rate and trends of indications of CS.Results: The results revealed that in the year 2001, the rate of CS at Sikkim was 10.1% and in the year 2011 it rose to 19.4%. The main indications for an elective cesarean in 2001 were previous CS (24.1%) and Cephalopelvic disproportions (16.5%). In the year 2011 along with previous CS (31.3%) another dominant indication for an elective cesarean was a maternal request (29%) for fear of childbirth without any co-existing medical indication. Anticipated fetal compromise remained the most common indications for urgent and emergency CS during both the study period.Conclusions: CS rate almost doubled over the last decade in Sikkim with a significant contributory factor in increasing proportion of CS were cesarean sections on maternal request without any co-existing medical or obstetric indication.