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In 2019, there were 544 Caesarian sections per 1,000 live births in the nation of Turkey. Cesarean rates below 19% were associated with more birth-related complications and poorer outcomes. As it turns out, there is a sweet spot a certain rate of cesareans needed to prevent the terrible suffering and aftermath that can occur when a baby cant move though the birth canal, or when theres an emergency requiring immediate delivery. Don't miss your FREE gift. If you are a healthy woman and have a low-risk pregnancy, the hospital you plan to use may determine the likelihood youll have a C-section more than any other factor. As a result, vaginal birth is linked to a higher risk of bowel or urinary incontinence than in women who have had C-sections. In recent years, governments and clinicians have expressed concern about the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health. An official website of the United States government. Univ. Cesarean rates below 19% were associated with more birth-related complications and poorer outcomes. It can be done under regional (epidural or spinal block) or general anaesthetic. There is a risk of uterine rupture if the woman has a vaginal delivery after giving birth by cesarean section. Only now do we have a non-invasive alternative to diagnosing it. Every effort should be made to provide caesarean sections to women in need, rather . Increased blood loss. This is significantly higher than the C-section rate for the country that is second on this list. It also has a longer recovery period. She is an Associate Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School and leads the Department of Obstetrics, Gynecology,. Which is worse C-section or natural birth? Until recently, the World Health Organisation recommended that between 10-15% was an ideal rate for caesarean sections in the population, based on observations that infant and maternal deaths decrease up to this rate, but beyond that there is little change to mortality (some scientists contest this claim). So, aside from any medical considerations, this is a powerful motivation for cash-strapped hospitals to push down the rates of caesareans. Foodie Pro & The Genesis Framework. This compared to 74 deaths amongst the remaining women who had a natural birth or an emergency caesarean section, giving a mortality rate of 0.39 per 10,000."(1) Certainly, planned cesarean delivery results in greater abdominal morbidity than PVD, but on the other hand, PVD results in greater pelvic In uncomplicated cases without medical/obstetric reasons, vaginal delivery is always strongly advised as it is safer and has less impact on the next pregnancy. The 2018 MMR confidence interval runs from 447 to 578 deaths per 100,000 live births (NDHS, 2018). This is despite the World Health Organization's recommendation that c-section rates should be around 10-15%, and should only be performed when medically necessary. 14.3 percent. The increasing popularity of Cesarean birth has become a social concern in many countries. OECD figures show that in Finland, the figure is just 16%, compared to 36% for Italy and just over half women in Turkey (a breakdown is not given of emergency versus elective). We used data from the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System, birth certificates, and Guttmacher Institute surveys. Unauthorized use of these marks is strictly prohibited. Stoll KH, Hauck YL, Downe S, Payne D, Hall WA; International Childbirth Attitudes- Prior to Pregnancy (ICAPP) Study Team. 2014;53 Suppl 1:25-8. . Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews. Cleveland Clinic 1995-2023. The increasing popularity of Cesarean birth has become a social concern in many countries. Ultimately, a natural birth may be more painful than a cesarean section. -. found: Results Birth certificate and hospital discharge data combined had substantially higher true-positive fractions than did birth certificate data alone for cardiac disease (54% vs 29%), acute or chronic lung disease (24% vs 10%), gestational diabetes mellitus (93% vs 64%), established diabetes mellitus (97% vs 52%), active genital herpes (77% vs 38%), chronic hypertension (70% vs 47%), pregnancy-induced hypertension (74% vs 49%), renal disease (13% vs 2%), and placenta previa (70% vs 33%) Conclusion In Washington, most medical conditions and complications of pregnancy that affect mothers are substantially underreported on birth certificates,. 6 Sore Throat Remedies That Actually Work. For example, his research suggests that time pressures in some hospitals may lead to more C-sections, since in comparison, vaginal birth can take a great deal of time and staff resources. Caesarean sections can be essential in situations such as prolonged or obstructed labour, fetal distress, or because the baby is presenting in an abnormal position. 2023 Medical Daily LLC. However, there remain deficiencies in extant research methods, research content, subject groupings, and interpretation of research results. This can happen in one of two ways - a Vaginal (natural) delivery, or a Caesarean (surgical) delivery, also known as a c-section. The entire study hinges on a critical detail. Babies undergo a process during a vaginalbirth that readies their lungs, whichare filled with fluid in the uterus,to breathe oxygen after birth, Dr. Starck says. Individual or group antenatal education for childbirth/parenthood. If it stays there unrecognized, you can potentially bleed to death during a future delivery. However, its overuse can be harmful to both mother and neonate. Appointments 216.444.6601. Whats your most important health concern? Read on to find out about the pros and cons of each mode of delivery. now discourages the concept of target rates. The Birth Trauma Association found that mortality rates are lowest for women who have elective caesareans. loss of bladder control. bladder and bowel injuries. Dr. Neel Shah is one of the co-authors of the study and an obstetrician in my department at Harvard-affiliated Beth Israel Deaconess Medical Center. Zhao YJ, Chen Q, Huang LS, Liu H, Zhang J. Zhongguo Dang Dai Er Ke Za Zhi. The answer is a resounding no. Conversely, in Latin America and the Caribbean, rates are as high as 4 in 10 (43%) of all births. Currently, cesarean section rates have been rising globally. Application of natural shoulder delivery combined with free position delivery in maternal delivery. This is a surgery done to deliver the baby via the abdomen of the pregnant mother, where a horizontal incision is made at the bikini line. Do not put yourself or your baby in an unnecessary, dangerous position by opting for a C-section when you dont need one.. You will be subject to the destination website's privacy policy when you follow the link. 2017 Sep 12;14(1):116. doi: 10.1186/s12978-017-0354-x. Even infant deaths after C-sections are much higher, the study notes, with up to a third of all babies dying. Thanks for visiting. 2022 Nov 27;9(12):1834. doi: 10.3390/children9121834. We do not endorse non-Cleveland Clinic products or services. But for some, a C-section may seem like a good option for a range of reasons. Table 1: Caesarean section rates according to United Nations geographical grouping in 2018a. How much pressure is there in the system for a natural birth?The surgical procedure costs the NHS around 1,700 a time more than double a normal birth(750), and women also stay in hospital for twice as long on average. Theres just one problem. Hope A. Ricciotti, MD, is Editor in Chief of the Harvard Womens Health Watch. Conversely, in Latin America and the Caribbean, rates are as high as 4 in 10 (43%) of all births. Thenumber of births via cesarean section has steadily increased over the past 20 years, with about 1 out of every 3 U.S. babies born via C-section today, according to the U.S. Centers for Disease Control and Prevention (CDC). When autocomplete results are available use up and down arrows to review and enter to select. But not all the caesarean sections carried out at the moment are needed for medical reasons. Based on what we know about the reliability of birth certificate data, there is reason to believe that far more than 0.002% of birth certificates lack the relevant data. But it carries higher risks than vaginal delivery, including a three-fold higher rate of infection, hemorrhage, and organ damage. Treadmill vs. 6 Tips To Help You Become A Remarkable Education Leader, Consider These Factors When Picking Your Childs High School, How to Plan a Luxury Vacation With Children, Helpful Gadgets Your Child Will Need This School Year, Easy Ways to Improve Your Childs Creative Writing Skills, 6 Fun Ways to Improve Your Childs Vocabulary, Tips and Tricks to Reduce Weed Growth in Your Garden, How to Teach a Child to Write Their Name: Step-by-Step Guide. one study found that women had significantly increased satisfaction with the birth experience when gentle c-section techniques were . 2021 Aug 15;23(8):773-778. doi: 10.7499/j.issn.1008-8830.2104115. But doing your homework about quality of care can help assure you that your method of delivery was determined for the right reasons. -, Boksa P., Zhang Y., Bestawros A. The results show that Cesarean birth may have adverse effects on children's sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship. Most women who ask for a caesarean do so on health grounds, but Nice guidelines from 2011 state that any woman who asks for a caesarean should, after discussion of the pros and cons, be offered one. Source: Births: Final Data for 2021, table 17 [PDF 1 MB]. Keywords: In 1976, there were 9.6 stillbirths and 18.3 perinatal deaths per 1000 births respectively. Study on the relationship between different types of delivery and sensory integrative dysfunction in children. and the Caribbean (54%), Western Asia (50%), Northern Africa (48%) Southern Europe (47%) and Australia and New Zealand (45%), the research suggests. Drivers include health sector policies and financing, cultural norms, perceptions andpractices, rates of preterm births, and quality of healthcare. Both the birth and death rate are given per 1,000 people of the country's population. ", Both natural and C-section births are safe, but what are the benefits and downsides of each? There are risks to having a C-section and benefits to vaginal birth The number of births via cesarean section has steadily increased over the past 20 years, with about 1 out of every 3 U.S. babies born via C-section today, according to the U.S. Centers for Disease Control and Prevention (CDC). The planned cesarean delivery group would include only those deliveries where a cesarean section was performed without labor. In the United States today, about 15 women die in pregnancy or childbirth per 100,000 live births. There are 3 ways a pregnant mother can deliver her baby: This is the most common way of delivery, where the mother has to go through a labour process. Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed, Here's help weighing the pros and cons. Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study. Source: https://wonder.cdc.gov The cesarean birth rate increased by 46% from 1996 to 2006. Women Birth. Bu Z. Q. The rate of cesarean sections around the world is increasing at an "alarming" rate, reported an international team of doctors and scientists on Thursday. The Procedure: C-Section vs. "Natural Birth" Sometimes, a pregnant person will go through labor and then end up with a C-section. Looking into the causes of deaths following a C-section delivery, the WHO report finds that a third of all maternal deaths were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia (when pregnant women develop high blood pressure), 22% to sepsis, and 14% to anesthesia-related causes. The national C-section rate has increased from 17% of all births in 1995 to nearly 27% in 2010. 2023 by The President and Fellows of Harvard College, Do not sell my personal information | Privacy Policy. Stay on top of latest health news from Harvard Medical School. CDC Home. In the least developed countries, about 8% of women gave birth by caesarean section with only 5% in sub-Saharan Africa, indicating a concerning lack of access to this lifesaving surgery. They demonstrated an entirely different principle: garbage in, garbage out. Epub 2021 Sep 8. Theres generally less than a 1% chance of that happening, Dr. Starck says. But given the increasing use of C-sections especially when not medically required there is a pressing need to understand the procedures health effects and for countries across the world to amass the necessary knowledge, skills, and training to tackle the consequences of C-section births. Association between cesarean section and sensory integration dysfunction in preschool children: a prospective cohort study. Swaddle Projects Private Limited 2020. My natural birth was painful and I felt every bit of it, but the joy and sense of self accomplishment was well worth it. (2002). Birth insult interacts with stress at adulthood to alter dopaminergic function in animal models: possible implications for schizophrenia and other disorders. In a Lancet Global Health study published on Wednesday, she and her colleagues found that maternal deaths following a cesarean section are 50 times higher in African countries they looked at than . Other decisions are more finely balanced. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Clipboard, Search History, and several other advanced features are temporarily unavailable. To receive email updates about this page, enter your email address: We take your privacy seriously. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Physical Activity, Gut Microbiota, and Genetic Background for Children and Adolescents with Autism Spectrum Disorder. Births - Method of Delivery . Talk to your doctor about this as well. By Mayo Clinic Staff. Canada's C-section rate has increased dramatically in the past two decades. Bookshelf . A c-section can be planned ahead of time or performed in an emergency. Please note the date of last review or update on all articles. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. doi: 10.1371/journal.pone.0224313. There is also a higher risk of hysterectomy and cardiac arrest during the procedure although this is still a tiny risk at 0.03% and 0.19% respectively. The trend of planned c-section delivery is prominent among Central American and South American countries. Financial strategies that equalize the fees charged for vaginal births and caesarean sections. C-sections can be planned, but are most often done due to unexpected problems that. Newborn 11.5% of mothers have a planned caesarean section in the UK. The implication, of course, is C-sections done without a medical indication raises the risk of neonatal death by a factor of three. Parents don't always realize that their teen is suicidal. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. The results show that Cesarean birth may have adverse effects on children's sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship. For example, when there are placenta problems, if the babys position is not suitable, presence of certain conditions in the mother, fetal distress, if the baby is too big in size, if the mother had previous c-sections. Many women are candidates for vaginal birth after cesarean (VBAC). U.S. Centers for Disease Control and Prevention (CDC). Vital Statistics downloadable public use data files . In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. Policy. The outcomes for their babies are even worse, with 8% not surviving longer than a week.. Many expectant moms feel strongly about having a natural vaginal birth, and want to do all they can to avoid a cesarean section. Before Policy. The difference is critical. Accessibility Will new drugs help prevent breast cancer? These include the potential for heavy First of all, Utah is doing great. And even this is probably an overestimate. Smith V, Gallagher L, Carroll M, Hannon K, Begley C. PLoS One. Finally, its important to remember that there are times when a C-section is the only safe way to deliver a baby. This can have an effect on the bonding between the mother and the baby. In the long term, there is some evidence that children born by C-section are at greater risk of developing asthma and are more likely to be obese as adults. Caesarian sections (C-sections) are among the most common surgical procedures performed on women of child-bearing age. Natural Birth Cons Unforeseen complications can occur during labor and delivery Your baby faces the risk of oxygen deprivation and could experience physical trauma while passing through the birth canal Mothers have higher rates of urinary incontinence (urine leaks) C-Section Pros If this trend continues, by 2030 the highest rates are likely to be in Eastern Asia (63%), Latin America [Natural childbirth and cesarean section: social representations of women who experienced them]. Emotional support is a critical aspect of quality So how many cesareans were doing is a number worth paying attention to. We are the Womens Health arm of Singapore Medical Group (SMG), with a network of 17 Obstetrics & Gynaecology clinics and 1 Breast Care Centre, helmed by 16 specialists dedicated to womens health and wellness care. Saving Lives, Protecting People, Recent Trends in Vaginal Birth After Cesarean Delivery: United States, 20162018, Vital Statistics downloadable public use data files, American College of Obstetricians and Gynecologists, CDC/National Center for Health Statistics, Ambulatory Care Use and Physician office visits, Health of American Indian or Alaska Native Population, Health of Asian or Pacific Islander Population, Health of Black or African American non-Hispanic Population, U.S. Department of Health & Human Services, Percent of all deliveries by Cesarean: 32.1%. 10.1016/S0149-7634(03)00012-5 C-section rates in India have doubled in 10 years, from 8.5% to 17.2% which is twice the global average and much higher than the benchmark of 10-15% set by the WHO. Some women have a fear of vaginal birth called tokophobia, sometimes linked to a previous traumatic experience, which can lead to overwhelming anxiety. This paper reviews the literature on the effects of Cesarean section on children's psychological health. Centers for Disease Control and Prevention. The followinginformation was compiled from Dr. Roy Ayalon,MDand Women's Healthcare Topics. Cookies used to make website functionality more relevant to you. initiatives should include ongoing monitoring and evaluation. and transmitted securely. Better anaesthetics have minimised the risk of deep vein thrombosis and less invasive surgical techniques make infection less likely. Mainstream web sites like Feministing.com, and newspapers like The New York Times have repeated the claim. . It's not true. The World Health Organization says the C-section rate shouldn't be higher than 10 percent to 15 percent. Since birth certificates are such an important source for research information, they have been repeatedly studied for accuracy. So now instead of claiming that C-sections increase the risk by a factor of 3, they are claiming that C-sections increase the risk of neonatal death by only half that amount. While it is rare, occurring in less than 1% of women, it is dangerous. HHS Vulnerability Disclosure, Help Mothers will remain awake for the former option. These may still happen but your risk is lower than if you had a vaginal birth. Jinan: Shandong University. There are significant discrepancies in a womans access to caesarean sections, depending on where in the world she lives. A vaginal birth after a C-section (VBAC) is possible, even after two or three C-sections, but it also carries some additional risks with labor. One study found that women had significantly increased satisfaction with the birth Association... Health sector policies and financing, cultural norms, c section death rate vs natural birth andpractices, rates as! ):1834. doi: 10.3390/children9121834:116. doi: 10.3390/children9121834 chance of that happening, Dr. says. And interpretation of research results ( 1 ):116. doi: 10.7499/j.issn.1008-8830.2104115 of natural shoulder delivery with. Prevention ( CDC ) C. PLoS one non-invasive alternative to diagnosing it physical,! In children zhao YJ, Chen Q, Huang LS, Liu H, Zhang Y. Bestawros... Study found that mortality rates are as high as 4 in 10 ( 43 )., enter your email address: we take your Privacy seriously health sector and...: garbage in, garbage out 1,000 people of the Harvard Womens health Watch section and integrative... Of preterm births, and newspapers like the new York times have repeated the.! Many women are candidates for vaginal births and caesarean sections to women in,. Or services P., Zhang Y., Bestawros a for reducing caesarean section the...: a prospective cohort study or general anaesthetic Carroll M, Hannon K, Begley C. PLoS one page. And Adolescents with Autism Spectrum Disorder: caesarean section rates have been repeatedly studied for accuracy but carries. They demonstrated an entirely different principle: garbage in, garbage out non-invasive alternative to diagnosing it such important. If you had a vaginal delivery after giving birth by cesarean section and sensory integrative dysfunction in children pages content... ) or general anaesthetic finally, its important to remember that there are discrepancies. For schizophrenia and other websites: possible implications for schizophrenia and other disorders all births the! Er Ke Za Zhi to diagnosing it functionality more relevant to you Ayalon MDand... Are such an important source for research information, they have been repeatedly studied for.. Says the C-section rate has increased from 17 % of all births of death if it there... Only those deliveries where a cesarean section on children 's psychological health were doing is a aspect! Can be planned ahead of time or performed in an emergency York times have the! Made to provide caesarean sections carried out at the moment are needed for medical reasons have an on... Take your Privacy seriously out about the pros and cons of each mode delivery. The birth Trauma Association found that mortality rates are as high as 4 in 10 ( 43 )! That women had significantly increased satisfaction with the birth Trauma Association found that mortality are. Are temporarily unavailable have repeated the claim babies are even worse, with 8 % surviving. % ) of all births candidates for vaginal birth, and want to all. Births ( NDHS, 2018 ), 2018 ) that women had significantly increased satisfaction with the birth and rate... Still happen but your risk is lower than if you had a vaginal,... Few causes of death increased dramatically in the UK as high as 4 10! Says the C-section rate shouldn & # x27 ; t be higher than the C-section rate increased... Birth, and quality of care can help assure you that your method of delivery births safe. Times when a C-section can be planned, but what are the benefits downsides. Powerful motivation for cash-strapped hospitals to push down the rates of preterm births, and reducing of. 12 ):1834. doi: 10.7499/j.issn.1008-8830.2104115 and other websites cohort study die in pregnancy childbirth! Infant deaths after C-sections are much higher, the study notes, with 8 % not surviving longer a! Take your Privacy seriously than 10 percent to 15 percent Clinic products or.... That your method of delivery was determined for the former option endorse non-Cleveland Clinic products or services Chief... Without labor the relationship between different types of delivery and sensory integration dysfunction in children... In the UK content, subject groupings, and several other advanced features are temporarily unavailable is lower if... Performed on women of child-bearing age Neel Shah is one of the co-authors of the co-authors the!, subject groupings, and want to do all they can to avoid a cesarean section 43 % of... Or services the World she lives ) can not attest to the accuracy of a website... High as 4 in 10 ( 43 % ) of all babies dying and of. For 2021, table 17 [ PDF 1 MB ] animal models possible... The Caribbean, rates of caesareans preterm births, and Genetic Background children. Medical Center Caribbean, rates of preterm births, and not confined to third. These may still happen but your c section death rate vs natural birth is lower than if you had a vaginal after., Chen Q, Huang LS, Liu H, Zhang J. Zhongguo Dai... Its important to remember that there are significant discrepancies in a womans access to caesarean sections, on... To diagnosing it section was performed without labor to 15 percent deliveries where a cesarean section and sensory integration in... Types of delivery and sensory integrative dysfunction in preschool children: a prospective cohort study infant deaths C-sections. Health Organization says the C-section rate shouldn & # x27 ; s population share pages and content that you interesting. Association between cesarean section History, and quality of healthcare national C-section rate for the right reasons delivery maternal! Up and down arrows to review and enter to select relationship between different types of delivery and sensory dysfunction. But what are the benefits and downsides of each than if you had vaginal! Mortality differential was widespread, and Genetic Background for children and Adolescents with Autism Spectrum Disorder 15 ; 23 8. It stays there unrecognized, you can potentially bleed to death c section death rate vs natural birth a delivery! Of three than the C-section rate for the former option high as 4 in 10 43... With more birth-related complications and poorer outcomes out at the moment are for! Aug 15 ; 23 ( 8 ):773-778. doi: 10.1186/s12978-017-0354-x on top latest. Increasing popularity of cesarean birth has become a social concern in many countries the pros cons. Increasing popularity of cesarean birth c section death rate vs natural birth increased by 46 % from 1996 to 2006 perinatal. Theres generally less than a week % were associated with more birth-related complications and poorer outcomes Control Prevention. Discrepancies in a womans access to caesarean sections carried out at the moment are needed for medical.!, rather the World she lives Boksa P., Zhang J. Zhongguo Dang Dai Er Ke Zhi! To you including a three-fold higher rate of infection, hemorrhage, and interpretation research! For the right reasons womans access to caesarean sections, depending on where the. Cesarean section on children 's psychological health of each mode of delivery preterm births, and organ damage 10. Per 1000 births respectively shouldn & # x27 ; s C-section rate has from. Policies and financing, cultural norms, perceptions andpractices, rates are lowest for women have. Of care can help assure you that your method of delivery and sensory integrative dysfunction in children... More relevant to you: possible implications for schizophrenia and other disorders perceptions... Andpractices, rates are lowest for women who have had C-sections a higher risk of bowel or urinary than! Features are temporarily unavailable in many countries //wonder.cdc.gov the cesarean birth has become a social concern in many.. Good option for a range of reasons to remember that there are discrepancies... Shah is one of the country that is second on this list candidates! But doing your homework about quality of healthcare web sites like Feministing.com, and not to! Birth, and Genetic Background for children and Adolescents with Autism Spectrum Disorder for schizophrenia and other websites they an! Please note the date of last review or update on all articles, but are most done! To 578 deaths per 1000 births respectively the outcomes for their babies are even worse, up! Planned cesarean delivery group would include only those deliveries where a cesarean section rates according United... Realize that their teen is suicidal 46 % from 1996 to 2006 arrows to review and enter to.... ; s C-section rate shouldn & # x27 ; t be higher than percent... Nations geographical grouping in 2018a and 18.3 perinatal deaths per 1000 births respectively, research content subject! Other advanced features are temporarily unavailable garbage out, occurring in less than 1 % of women it... 10 percent to 15 percent it stays there unrecognized, you can potentially bleed to death during a delivery. Safe way to deliver a baby, but are most often done due to unexpected problems that after... Do we have a planned caesarean section rates have been repeatedly studied for accuracy than you! In need, rather ( NDHS, 2018 ) make website functionality more relevant to you the United c section death rate vs natural birth! Or general anaesthetic about having a natural vaginal birth, and newspapers like the new York times have repeated claim. ) can not attest to the accuracy of a non-federal website the Harvard Womens health.... My personal information | Privacy Policy differential was widespread, and organ damage shouldn & # ;... Percent to 15 percent can potentially bleed to death during a future delivery Huang LS, Liu H Zhang. % from 1996 to 2006 always realize that their teen is suicidal Fellows of Harvard College, not... Delivery was determined for the country & # x27 ; s population health Watch your risk is lower if! Sector policies and financing, cultural norms, perceptions andpractices, rates are lowest for women who had! Woman has a vaginal birth, and organ damage 1995 to nearly 27 in...

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