Experts state that the cesarean section rate in Turkey is well above the reasonably accepted 15 percent limit, with almost one out of every two children being born via C-section.
Dr. Tuğba Yılmaz Esencan, a faculty member of the Midwifery Department at the Faculty of Health Sciences, stated that cesarean section is a method that should not be preferred unless there is a medical necessity, saying, “When complications that could endanger the health of the mother and baby arise, cesarean delivery may become necessary as a vital intervention. Furthermore, it should not be forgotten that a cesarean section is not a birth method but a compulsory surgical intervention, and its widespread use can have negative effects on public health.”
Dr. Tuğba Yılmaz Esencan, Associate Dean of Üsküdar Üniversitesi Faculty of Health Sciences and a faculty member of the Midwifery Department, provided information on the birth process, birth methods, and the effects of cesarean section and natural birth.
The birth process is extremely important for the health of the mother and baby
Dr. Tuğba Yılmaz Esencan stated that the birth process is an extremely important period for the health of the mother and baby, saying, “During this process, for the birth to progress in its natural flow, the expectant mother must feel safe, be respected, have her privacy protected, be provided with freedom of movement, and receive continuous physical and emotional support. These are indispensable elements of a positive and safe birthing environment. An expectant mother who gives birth in an environment where these needs are met will be more comfortable and peaceful; this contributes to the healthy progression of the birth process.”
Cesarean birth: A necessity or a preference?
Regarding cesarean birth, Dr. Tuğba Yılmaz Esencan said, “When chosen outside of medical necessities, cesarean birth can have negative effects on maternal and infant health. Scientific studies show that babies born via C-section more frequently experience asthma, respiratory infections, and allergic diseases, face breastfeeding difficulties, and have impaired mother-baby interaction. Furthermore, cesarean section prolongs the mother's recovery process after birth, making physical and mental recuperation more difficult. However, in some situations, a cesarean section can be a mandatory intervention for the mother and baby. In high-risk pregnancies or complications during labor, a cesarean can save the lives of both the mother and the baby. At this point, it is crucial to correctly differentiate between situations where a cesarean is necessary and unnecessary interventions. Cesarean delivery can be considered a healthy option, especially when it becomes mandatory due to risks faced by the mother or baby during birth.”
Almost one in every two children is born via C-section
Dr. Tuğba Yılmaz Esencan stated that the high rates of cesarean sections are a significant health problem in our country and continued:
“In our country, this rate is well above the 10-15 percent level recommended by the World Health Organization (WHO). According to the 2022 Health Statistics Yearbook data, the cesarean section rate in Turkey is well above the reasonably accepted 15 percent limit, with almost one out of every two children being born via C-section. While the total rate of cesarean sections among hospital births in all state, university, and private hospitals was determined to be 62.8 percent in 2022, this rate was recorded as 60.9 percent in 2021 and 59.6 percent in 2020. In university hospitals, the cesarean rate reached 75 percent. In state hospitals, the rate of cesarean sections among hospital births was 42.8 percent in 2020, 44.6 percent in 2021, and increased to 46.4 percent in 2022. Therefore, we must take action and implement measures.”
What lies beneath the increasing cesarean rates?
Dr. Tuğba Yılmaz Esencan noted that factors such as “fear of childbirth, advanced maternal age pregnancies, and the perception of cesarean section as an easier option” underlie the increase in cesarean rates. She added, “However, unless there is a medical necessity, natural birth is recommended. Cesarean section is a method that should not be preferred unless medically indicated. When complications that could endanger the health of the mother and baby develop, cesarean delivery may become necessary as a vital intervention. This decision ensures the selection of the healthiest delivery method for both mother and baby. Furthermore, it should not be forgotten that a cesarean section is not a birth method but a compulsory surgical intervention, and its widespread use can have negative effects on public health.”
Natural birth also reduces the risk of postpartum depression
Dr. Tuğba Yılmaz Esencan also stated that cesarean birth negatively affects the postpartum bonding process between mother and baby, and delays in early contact and breastfeeding can lead to health problems for infants later in life. She said, “We should also consider that the oxytocin hormone secreted during natural birth facilitates the natural progression of labor, strengthens the bond between mother and baby, and reduces the mother's risk of postpartum depression.”
There are misconceptions that babies born via C-section are more intelligent
Emphasizing that natural birth offers many health advantages for both mother and baby, Dr. Tuğba Yılmaz Esencan stated, “During the natural birth process, the baby is exposed to important bacteria for gut microbiota as it passes through the birth canal, which contributes to the development of the immune system. It is stated that babies born through natural birth receive more breast milk and are more resilient, and these advantages may decrease in mothers who undergo cesarean sections. Cesarean delivery, on the other hand, stands out as a life-saving surgery in emergency medical situations. Cesarean can be preferred when the baby is in a breech position, if the mother's pelvic structure is unsuitable, or if there are labor complications. However, the perception of cesarean birth as a symbol of wealth at one time and the false beliefs that babies born via C-section are more intelligent have contributed to the increase in cesarean rates.”
What are the possible risks for the mother and baby during natural childbirth?
Dr. Tuğba Yılmaz Esencan stated that despite the naturalness of natural birth, some risks exist, and continued:
“The natural birth process is a journey of surrender whose end cannot be clearly foreseen. Unexpected situations can occur. What is truly important here is how we can cope with these situations and the presence of a midwife accompanying us on this journey. Prolonged labors can lead to physical exhaustion and birth trauma for the mother. Also, from the baby's perspective, a prolonged labor duration can lead to a drop in oxygen levels. However, most of these risks can be minimized with medical interventions. This is where the importance of the pregnant woman and the midwife's partnership in childbirth emerges. The presence of a midwife during birth will help a woman experience an unforgettable birth journey. This situation should be considered independently of the birth method. Every woman's birth journey is unique, singular, and one of a kind. Whether it's a cesarean or a natural birth, if a woman has been able to write her own story in her birth journey, and if the mother and baby are healthy, then the main goal has been achieved. However, it should also be remembered that promoting natural birth can protect the long-term health of both mother and baby.”
Benefits of natural birth for mother and baby
Dr. Tuğba Yılmaz Esencan noted that as an intervention-free process, natural birth allows the mother and baby to experience positive physiological, psychological, and emotional effects. She stated, “Hormones secreted during birth facilitate mother-baby bonding, contribute to faster breast milk production, and more successful breastfeeding. Furthermore, as the baby passes through the birth canal, its gut flora develops, strengthening the baby's immune system. The mother's faster physical and mental recovery after birth is another significant advantage of natural birth. When a traumatic birth experience is avoided, the mother can adapt more easily to her new roles and childcare after birth. Although pregnancy and birth are described as a developmental crisis in a woman's life, every birth is actually a process where a woman is born into her own motherhood and becomes stronger.”
What are the potential risks of cesarean birth?
Dr. Tuğba Yılmaz Esencan stated that in the short term, cesarean birth can prolong the mother's recovery period and lead to more pain. She concluded by saying, “It can also negatively affect the postpartum mother-baby bonding process. Another dimension of risk is that mothers after cesarean section may face a higher risk of postpartum depression, and this situation can weaken the mother-baby bond. In the long term, health problems such as asthma, allergies, and obesity are more frequently observed in babies born via C-section.”