1.O. Workshop: Caesarean section in Europe: Are women and babies receiving evidence-based obstetric care?

Every year in Europe, over 1.5 million women have a caesarean section (CS). The use of this surgical procedure is increasing globally, leading to concerns about a caesarean “epidemic”. While CS is a lifesaving procedure for mothers and babies with complications during pregnancy or labour, national variations in CS rates suggest the absence of standardised indications: in Europe rates vary from lows of 16% (Nordic countries, the Netherlands) to over 40% (Poland, Romania, Greece, Cyprus). Worldwide, the gap between low and high CS countries is even greater. To assess the magnitude of the variations in CS in terms of numbers of women experiencing the procedure in Europe, the Euro-Peristat network calculated that there would be 500,000 fewer CS if all countries had the rates in the lowest CS country. There is uncertainty about what the “optimal” CS rate should be and how this might differ in relation to the health of the childbearing population. CS risk is associated with characteristics of the childbearing population, such as older maternal age, nulliparity, higher body mass index and maternal chronic conditions. The optimal CS rate may also differ depending on the organisation and capacity of the health system. European countries provide a unique context for exploring these questions they have similar standards of living and access to advanced medicine, but differ greatly in the organisation of their health systems and CS practices. In this session, we will present three studies reporting recent data on CS variations and trends in Europe from the Euro-Peristat network to shed light on these questions. The presentations will be followed by a round table discussion about the next steps for evaluating the reasons as well as the health impact of varying practices in order to ensure that European women receive evidence-based obstetric care. KEY MESSAGES: • The persisting variation in the use of caesarean section between European countries raises questions about whether pregnant women and babies are receiving evidence-based care. • Europe provides a unique context for exploring these variations because despite high standards of living and access to medical care, marked differences persist between countries.