Correlation of Cesarean rates to maternal and infant mortality rates: an ecologic study of official international data

OBJECTIVE: To correlate international official data on Cesarean delivery rates to infant and maternal mortality rates and low weight-at-birth rates; and to test the hypothesis that Cesarean rates greater than 15% correlate to higher maternal and infant mortality rates. METHODS: Analyses were based on the most recent official data (2000-2009) available for 193 countries. Exponential models were compared to quadratic models to regress infant mortality rates, neonatal mortality rates, maternal mortality rates, and low weight-at-birth rates to Cesarean rates. Separate regressions were performed for countries with Cesarean rates greater than 15%. RESULTS: In countries with Cesarean rates less than 15%, higher Cesarean rates were associated to lower infant, neonatal, and maternal mortality rates, and to lower rates of low weight-at-birth. In countries with Cesarean rates greater than 15%, Cesarean rates were not significantly associated with infant or maternal mortality rates. CONCLUSIONS: There is an inverse exponential relation between countries' rates of Cesarean deliveries and infant or maternal mortality rates. Very low Cesarean rates (less than 15%) are associated with poorer maternal and child outcomes. Cesarean rates greater than 15% were neither correlated to higher maternal nor child mortality, nor to low weight-at-birth.