Forceps/vacuum birth hazard: Asia survey

One big surprise of the WHO survey of Asian births was that "operative vaginal delivery" -- the use of forceps or vacuum -- had the highest death rate for mothers of any method.

Ninety-seven women died during the 108,000 surveyed births. Of those, 53 died during spontaneous vaginal births, as would be expected, given that those were the majority of births (75,000 deliveries), for a rate of less than .1 percent.

However, of 3,465 OVD births, nine mothers died, a rate of nearly .3 percent. In a commentary that accompanied the WHO report in the medical journal The Lancet, the editors called the figures "a sobering reminder of the dangers of operative deliveries," although they noted that most OVDs are "high-risk situations that cannot be easily avoided."

Twenty-three of the 16,500 mothers having Caesaean sections "with indications" during labor died (more than .1 percent), and one woman died of the 554 having elective C-sections during labor (a rate of nearly .2 percent).

The report also found that women undergoing elective Caesarean section were  far more likely to spend time after the birth in intensive care than women whose births were spontaneous.

The irony is that while many unnecessary C-sections are being performed in some areas, women in other areas who desperately need them are not able to get them, the WHO report notes.

Birth in Asia — The WHO survey

The rising rate of birth by Caesarean sections has hit Asia, with China reporting that 46 percent of its births now end in surgery, according to a global survey by the World Health Organization reported in the medical journal The Lancet.

Nine countries were targeted in the WHO study -- Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam -- with births in both small and large institutions examined for two or three months in the capital city and two other regions in each country. In all, about 108,000 births were scrutinized at 122 institutions.

China had the highest rate of Caesarean births in the survey. The country with the next-highest rate was Vietnam, with 36 percent, followed by Thailand, with 34 percent, and Sri Lanka, with 31 percent.

Cambodia had the lowest rate of Caesarean births, 15 percent, which is the rate the WHO and other health groups recommend. The C-section rate over all for the Asian countries surveyed was 27 percent.