The Increasing Trend in Cesarean Sections in South Eastern Italy: Medical and Biopolitical Analysis of Causes and Possible Mechanisms for Its Reduction.

Abstract: Caesarean section (CS) rates are rising globally, though with considerable variation from country to country; in Italy the CS rate is about 38.2% and in Puglia, a region in the South-east (4 million inhabitants), the CS rate is about 47.7%, up 4.25% in the last two years. Currently, the high rate of CS and operative delivery in developed countries may be attributed to larger foetuses, an increase in the frequency of diabetes mellitus and pelvic adiposity, advanced maternal age at first pregnancy and a decrease in tissue elasticity. Moreover patients have a very low acceptance of any maternal-foetal risk in labour, and there is a significant increase of CS “on maternal request”. Studies of communities with low rates of caesarean delivery may help to identify factors that lower the CS rate, such as cultural attitudes toward childbirth, design of the perinatal system, and genetic and social aspects. Also needed are biopolitical projects for the rationalisation of human and technological resources, which may lead to a reduction in legal claims and a natural decrease in defensive practices or defensive obstetrics based on doubtful diagnoses. Furthermore, the number of caesarean deliveries performed “on maternal demand” should be reduced by making sure that women are adequately informed about the safety of vaginal versus caesarean delivery. National health programs should be instituted and extended to large populations, showing the costs and benefits of vaginal versus CS delivery. This analysis reviews the current reasons for performing CS, analyzing limitations in labour management and focusing on dystocia, in order to identify possible socio-political and medical mechanisms that may reduce the CS rate in south-eastern Italy, including promising but under-used technologies.