The number of Caesarean sections grows in Spain year after year despite have many more complications than vaginal birth.

-Although a caesarean section may have fewer complications for the fetus, maternal mortality increases between 5 and 6 times

– there are certain groups of pregnant women who crowd the 64.5 per cent of the indications for caesarean sections, with factors that could be modified to reduce this rate.

– scientifically proven upon ripening the cervix substantially increases the possibilities of vaginal delivery, and less Caesarean sections. The method of choice is the application, by means of a device of prolonged release of prostaglandins.

Madrid, October 2011.- The Cesarean rate grows without stopping in the majority of developed countries, sometimes reaching triple recommended by the who that lies between 10 and 15 per cent; is conventional wisdom that this increase is partly due to reasons not justified clinically, such as the particular appropriateness of some pregnant women or specialists who care, increasing demands in the specialty, the fetal viability before possible pathologies (that it has lowered the 24 week of gestation), teams with less experience in tocurgialess dangerous than before caesarean section, or the lack of adherence to protocols work, among others.

The idea behind the general population is caesarean section to simplify the delivery and print security on the fetus being safe for the mother. Scientific evidence shows that this increase in caesarean section policy is detrimental to medium and long term on maternal health and infant, ostensibly to increase health care costs.

Significantly increase the direct costs of surgery and hospitalization, the risk of second Caesarean sections or more sick leave, among others. The decrease of one percentage point in the rates of caesarean section versus vaginal delivery, would produce savings close to 6 million euros a year in all Spain ”, says Dr. Eduardo Cabrillo, Chief of obstetrics and Gynaecology of the La Moraleja Hospital service.

There are certain groups of pregnant women who crowd the 64.5 per cent of the indications for caesarean sections, with factors that could be modified to reduce this rate: women in their first pregnancy to term induces the delivery term already sometimes have given birth and women with a previous caesarean section andFinally, pregnant with the fetus in breech (from bottom).

For Dr. Juan Luis Delgado Marín, Coordinator of the unit of medicine Materno-Fetal of the Hospital Universitario Virgen of the Arrixaca Murcia, the classic a greater number of inductions paradigm, greater number of Caesarean sections should be replaced by a more properly listed and led labor inductionssmaller number of Caesarean sections, based on scientific evidence. Improve the conditions of the cervix (cervix), maturing previously, substantially increases the chances of success in childbirth safely for mother and son ”.

And continues of all methods to promote this maturation, local prostaglandins, administered through an extended release device, are the method of choice without any discussion. Have been postulated other methods to ripen the cervix, since methods “natural” (performed sexual intercourse often days before childbirth, products of herbal medicine, acupuncture, homeopathy, etc.) up methods more invasive as the flaps of the membranes of the bag, the break artificial membranes or the direct use of intravenous oxytocin, but none of them exceeds the prostaglandins in the maturing effect on the cervix ”.

On the other hand, is essential to driving correct delivery, optimizing the protocols of care for the pregnant woman in the last weeks of pregnancy, improving circuits of induction of labor in hospitals, forming to the professionals involved, continually re-evaluating the results and the satisfaction of the parents, adapting the times of care for the pregnant woman with childbirth induced according to guidelines of the delivery of the SEGO (women with labor induction has initially very unfavourable birthing obstetric conditions, so it must be given adequate time to make progress in the delivery). In this way, increases the level of adequacy of induction and minimizes the number of Caesarean sections by failed inductions.

According to experts there to eliminate indications of elective induction of labor by convenience of the mother and the gynecologist (inconvenience and overloading of the end of the gestation, apparently large babies, convenience of dates, etc.) that they do not pose risk to fetal health, and yes they can lead to a prolonged laborunwanted by anyone, or c-section for failing the induction of labour. The Spanish society of gynaecology and obstetrics Association (SEGO) establishes that the optimum time to induce childbirth in pregnant women in low-risk term is between 41 and 42 weeks of gestation, whereas as the post-term pregnancy that extends beyond the week 42, period in which exponentially increases the risks to the fetus.

Although caesarean section may have fewer complications for the fetus, it can be assumed grave consequences for the mother with complications by bleeding, possible urinary or intestinal injuries, infections, thrombophlebitis, etc., increasing mortality because it should not be forgotten that this is one major operation. Maternal mortality increases between 5 and 6 times in the case of a caesarean section, ensure the experts meeting in Malaga recently in the V Symposium of obstetrics, Ferring-sponsored.

The data show that the number of interventions is even greater in private care, around 40% compared to 23-25% of the public, due inter alia to the doctor usually work alone, so there are private hospitals that are developing programs to meet the delivery teamto equivalence of the public health system, thereby facilitating the vaginal delivery.

Experts point out that cervical ripening should be obligatorily performed in those pregnant women with unfavourable cervix (rigid, without delete, barely dilated uterus necks, etc.), but also offers good results in patients with obstetric conditions – without contractions-since the start of the delivery is much more effectivethe dilation is achieved at an optimal rate and shortens the time of delivery. To analyse not only the clinical or medical benefits, but the cost of such conduct, the induction of labour with prostaglandins is the option with greater cost-effectiveness in the pregnant woman to a conclusion.

For its part, induction is recommended provided that there is minimal risk to mother or fetus, in the case of pathological pregnancies, and at the end of the gestation in low-risk pregnancy, with strict control of mother and child, risks are minimal, comparable to any delivery of spontaneous onset.