“It’s a critical situation”: A call to action in the face of record numbers of cesarean sections in Puerto Rico

Cesarean sections in Puerto Rico reached a record number in 2022 after registering 50.5%. Birth by surgery, according to A A recent study Published by Centers for Disease Control and Prevention (CDC, in English).

This figure exceeds the 32% reported at the United States level, and the scenario on the island is complicated by a widely reported crisis over a shortage of obstetricians and anesthesiologists in hospitals, which has closed more than a dozen delivery rooms. last decade.

According to CDC research, between 2010 and 2018, the cesarean birth rate in Puerto Rico was between 46.3% and 48.4%. However, it continued to grow until it reached 50.5% two years ago.

The report states that Just over half of domestic births were surgical, increasing costs and risks for mothers.

“It is a critical situation, which we must continue to try to mitigate. It must be recognized that it is a complex problem, involving multiple factors. It is not directly from obstetricians, but from the dramatic shortage of anesthesiologists in this country.“, the medical director of the institute expressed this Wednesday PROGyn, Navel Bracero.

A subspecialist in reproductive endocrinology and infertility noted that cesarean sections skyrocketed during the epidemic. COVID-19, because “many of the anesthesiologists who served at the hospital have retired.” He estimated that about 150 of these professionals remained for the entire island.

Similarly, Bracero explained that “the birth process, ideally, one wants to happen naturally (vaginally), but it can become an emergency cesarean section at any time. When a complication occurs, it happens catastrophically, where mother and baby can be affected, so an obstetrician feels calm with an adequate service when there is an anesthesiologist in the hospital.“

In 2022, cesarean birth rates increased primarily among mothers under 20 (from 37% to 42%).. Similarly, 64.5% of births to mothers aged 40 or older were by this surgery, up from 60.6% in 2018.

Cesarean section is associated with short- and long-term risks, which may persist for several years after the intervention and affect the health of the woman and the newborn, World Health Organization (WHO).

In light of the CDC report, the largest increase in cesarean sections in Puerto Rico was among preterm births: from 45.9% in 2018 to 52.1% in 2022. Additionally, in the same period, towns where caesarean sections were performed Pons (39.7% to 46.1%), San Juan (43% to 49.4%) and Baymon (57.1% to 63.9%).

For a pro-independence senator MARIA DE LOURDES SANTIAGO NEGRONThe CDC report is alarming because, according to it, it shows a “lack of regulation” of obstetrics on the island to prevent a dramatic increase in cesarean sections.

“These data are an indication that, contrary to what obstetricians have represented when they opposed legislation on the subject, the profession is incapable of self-regulation.“, he noted, the cesarean section rate recommended by the WHO is between 10% and 15%.

Santiago Negron, on more than three occasions, has introduced measures to create a “law for access to statistical data on cesarean sections in Puerto Rico.” He Senate Bill 225Submitted in 2021, it is still before the House of Representatives’ Health Committee for consideration.

“It is important to see this in the context of the hospital crisis and the denial and resistance that exists to other forms of birth, including (including) nurse-midwives and doulas, which are proven sources. It works.“, stressed the senator.

Bracero, for his part, recommended “increasing the provision of anesthesiology services in hospitals and asking health plans to cover ancillary services and adequately reimburse people such as nurse-midwives, but within the hospital. “They adequately reimburse doula services, because all of these things that help patients through the childbirth process have been seen to definitely reduce the rate of cesarean sections.”.