The WHO’s recommended C-section rate is fake news

fake news and misinformation concept

Another day, another piece demonizing C-sections.

How the C-Section Went From Last Resort to Overused was written by Rebecca Onion and appears on Slate. We don’t even get to the body of the piece before the first falsehood appears. The subtitle is: The history of the surgery is rife with horror, but today, 1 in 3 American babies are delivered via the procedure, twice what the World Health Organization recommends.

There’s just one problem. The World Health Organization’s recommendation is fake news.

It is this fake news that forms the heart of Onion’s piece:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The WHO’s optimal C-section rate less than 15% is no different from Wakefield’s claim that vaccines cause autism. Both are lies in the service of ideology.[/pullquote]

C-sections remained extremely rare throughout the 19th century. Even after the mid-20th-century advent of antibiotics and blood transfusions, which rendered the surgery much safer, the national rate of C-sections remained low. Then, the procedure exploded. Between 1965 and 1987, it rose 455 percent. Today, despite the work of the birth-reform movement of the ’70s and ’80s, 1 in 3 babies are still delivered by C-section. That’s twice the recommendation set by the World Health Organization, which states that a 10–15 percent rate is the ideal, since a rate higher than that has been assessed to have no effect on mortality rates, even as it pushes up medical costs and increases other risks for both mother and baby.

We live in a world where we have stopped battling over ideas, and started battling over facts themselves. Facts no longer inform beliefs; ideology begets lies masquerading as “facts” in service to a predetermined conclusions. We call this fake news.

One of the original examples of fake news is the World Health Organization’s recommended C-section rate. The WHO “optimal” C-section rate of 10-15% is a bald faced lie. It was fabricated from whole cloth apparently by a single physician; there was NEVER any evidence to support the lie when it was first released in 1985 and it has been thoroughly debunked repeatedly in the past 30 years. No matter.

The WHO’s claim that the optimal C-section rate is less than 15% is no different than Andrew Wakefield’s claim that vaccines cause autism.

I don’t say that lightly.

Wakefield’s claim has been used, as he intended, to call the safety, efficacy and desirability of vaccines into question and to demonize them. The WHO’s optimal C-section rate has been used, as Marsden Wagner its fabricator apparently intended, to call the safety, efficacy and desirability of C-sections into question and to demonize them.

Both claims were made up to serve the interests of the individuals who fabricated them.
Both NEVER had any support in the scientific evidence.
Both have been repeatedly debunked.
Both are fervently believed by some people despite the lack of evidence.
Both cause serious harm and very little good.

Marsden Wagner, a pediatrician who served as the European Head of Maternal and Child Health for the World Health Organization, appears to have been the driving force behind fabricating and publicizing the fake news optimal C-sections rate. Wagner, without any evidence of any kind, convened a conference of like mind health professionals in 1985 and they simply declared the optimal rate of less than 15% by fiat.

Many years later, Wagner inadvertently acknowledged that the “optimal” C-section rate was simply made up. In his 2007 paper Rates of caesarean section: analysis of global, regional and national estimates:

… [T]his paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health. (my emphasis)

Wagner had been touting an optimal C-section rate under 15% for 22 years before he even bothered to check whether it had any basis in reality. And although Wagner ended up “confirming” the fabricated optimal rate, the data showed the opposite. There were only 2 countries in the world that had C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries were Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% had unacceptable levels of perinatal and maternal mortality.

In 2009, the World Health Organization surreptitiously withdrew the target rate. Buried deep in its handbook Monitoring Emergency Obstetric Care, you can find this:

Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …

In 2015 researchers from Harvard and Stanford — including Neel Shah, MD and Atul Gawande, MD, put a stake through its heart in the paper Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.

They found:

The optimal cesarean delivery rate in relation to maternal and neonatal mortality was approximately 19 cesarean deliveries per 100 live births.

According to the press release that accompanied the paper:

“This suggests on a policy level that benchmarks for C-section rates on country-wide level should be reexamined and could be higher than previously thought.”

The graphs they created are quite impressive:



These graphs show that C-section rate below 19% lead to preventable maternal and neonatal deaths. In other words, they show that the WHO “optimal” rate, far from being optimal, is actually deadly. They also show that C-section rates above 19% are NOT harmful. There appears to be NO increased risk of either maternal or neonatal mortality for rates as high as 55%.

Why is the WHO continuing to disseminate fake news? Why are they demonizing C-sections?

Because they honestly believe — in the absence of any scientific evidence and in the face of their claims having been debunked — that C-sections are “bad.” It’s the same reason that anti-vaxxers disseminate fake news about vaccines and demonize them. They honestly believe — in the absence of any scientific evidence and in the face of their claims having been debunked — that vaccines are “bad.”

Both are wrong. Sadly, it is women and babies who pay the price for their fake news.