False beliefs about the indications of caesarean section in the Romanian population

Abstract

There has been a considerable increase in the number of caesarean sections (C-sections) in the last 30 years. Between 2009 and 2017, Romania has reported an increase with 32.1% of the number of C-sections. The consensus regarding the obstetrical indications of the caesarean section has changed. This is mainly due to improvement in appreciating more specific fetal death risks or fetal hypoxemia, and to allow pregnancy for severe medical conditions (kidney transplant, valvular cardiac prostheses etc.). The caesarean section rate is also increased by the number of C-sections at the patient’s request. Some patients request a caesarean delivery without a valid medical indication because they are afraid of episiotomy, of prolonged and painful labor, vaginal trauma or urinary incontinence associated with a vaginal birth or because of some false medical beliefs. Our article focuses on evidence-based medicine on false beliefs about the indications of the C-section in Romania, the intriguing tale of how pregnant women request a C-section, sometimes encouraged by healthcare givers. The analyzed indications which are misbelieved are: fetal nuchal cord, oligohydramnios at term for normally structured fetuses, maternal obesity, fetal macrosomia, the 40-week pregnancy, hepatitis B and C, human papillomavirus (HPV) infection, and uncomplicated myopia.