Global trend in cesarean sections: indications, risks, and the situation in Ukraine

In recent years, the share of births by cesarean section has been growing worldwide - according to WHO forecasts, by 2030 the global average will reach 30%. Read about the situation in Ukraine and the possible consequences of this trend in the UNN article. 

Global dynamics 

In 1990, the share of births performed by cesarean section in the world was 7%, and in 2018 it was already 21% and continues to grow. Of course, these figures are averaged and depend on the country. For example, in the USA, according to data from the National Center for Health Statistics, in 2025 the number of women in labor who underwent such surgery rose to 32.5%. In Brazil, the share of such births is even higher and can reach 50% in private clinics. Meanwhile, in some countries, women cannot receive such a medical service even in the presence of direct indications. For example, in some African countries, the share of cesarean sections does not exceed 5%. Although, according to WHO recommendations, the optimal percentage of such interventions is between 7% and 15%. 

What is the situation in Ukraine? 

Statistics show that in Ukraine, the share of births by cesarean section is also steadily growing. The latest published official data show that in 2024, the share of such births reached 29.7%, whereas back in 2018 it was 22.3%. At the same time, as reported by the National Health Service, in some facilities this figure exceeds 40%.  

At the same time, in Ukraine, a woman's simple desire is not enough to perform such an intervention. Medical grounds are required. Indications for a cesarean section can be absolute (for example, placenta previa or placental abruption, which carries a risk of bleeding); relative (a scar from a previous cesarean); and emergency (weak labor activity). 

A planned cesarean section is usually scheduled for the 39th week, when the fetus is already formed and ready for life outside the mother's womb. But every case is unique and requires careful study – from relevant blood tests to consultation with related specialists. 

So why are cesareans being performed more and more often? 

One of the reasons strongly influencing the spread of the growing trend of cesareans in the world is tokophobia. This is a pathological fear of pregnancy and childbirth. This fear can occur both in women who have already gone through a difficult birth and in those who have not yet given birth. Women are not just afraid of pain, but feel fear for themselves and for the child. Quite often, such pregnant women demand a cesarean. In some countries, tokophobia can be the primary basis for performing the operation. In Ukraine, the situation is somewhat different, as the pregnant woman's desire alone is not yet a ground for intervention. Tokophobia can be considered as a reason that hinders the normal course of pregnancy or become a basis for a cesarean if the fear of natural childbirth affects the woman's mental health. 

That is, in Ukraine, in the vast majority of cases, a woman's fear cannot be considered an indication for a cesarean. But why is the number of such births growing? As explained in an interview with UNN by the Director of the Kyiv Perinatal Center, Honored Doctor, obstetrician-gynecologist of the highest category, Doctor of Medical Sciences Dmytro Govseiev - one of the reasons is a significant share of women in labor who have already undergone a cesarean before. Also, in Ukraine, the list of medical indications for which such an intervention is prescribed has been expanded and, unfortunately, more and more women fall under them (specifically referring to breech presentation, uncorrected weakness of labor activity, etc.). 

When risks outweigh desires

WHO defines cesarean section as a complex operation that requires a series of preoperative, intraoperative, and postoperative stages, which can generally be classified into surgical, pharmacological, and anesthesiological interventions. Like any surgical intervention, cesarean section is associated with short-term and long-term risks that can last many years after the current birth and affect the health of the woman, her child, and future pregnancies. 

A woman must be aware of the possible risks. And the doctor's task is to do no harm. 

And for a doctor, it is important not to interfere with nature. Childbirth is a natural process. And the doctor's task, first and foremost, is to see the pathology in time and intervene, rather than interfering or rushing the process for some convenience

This position of the medic is also confirmed by studies of risks associated with childbirth. To begin with, the recovery of a woman after a cesarean lasts longer than after a natural birth. The risk of infection is also higher. WHO data show that children born via cesarean section have a higher predisposition to developing asthma, obesity, and immune system problems.  

Cesarean section is a full-scale operation and it has consequences for the woman's body as well. 

Unfortunately, there is now such a pathology – placenta accreta. This is a serious pathology that can ultimately lead to the need for a hysterectomy. When I was studying, no one could show us this – it almost didn't exist. Previously, only 9% of births were by cesarean. And we were not praised for this. Now it is 30% of births. And there will be more. And not only because women want it, but also because the list of indications has been expanded. And with the first scar, few doctors now opt for natural birth. And this provokes the development of the pathologies I already mentioned

At the same time, medical science does not stand still; for example, at the capital's Perinatal Center, they perform a unique organ-preserving operation in case of placenta accreta. In world practice, such operations belong to the category of rare and extremely complex. Every year, up to 20 such highly specialized interventions are performed at the Kyiv Perinatal Center. However, as Govseiev explains, it is not possible to save the organ in all cases.