Rising trends and indication of Caesarean section in Indonesia

Ali Sungkar, Ray Wagiu Basrowi


The rate of Caesarean delivery is rising dramatically worldwide, and also nationally. The number of Caesarean births exceeds the WHO recommended rate. This study aims to provide an overview of current increasing trend of Caesarean section, including elective procedure, and its risk. A review was conducted using online database, surveillance reports, and national surveys to identify studies with topics of prevalence, trend, indications, and risks of Caesarean delivery. Overall, there is an increase of Caesarean section in global, Asia, and Indonesia setting. We found an increase of 8% from 2013 to 2018 based on population survey, and increase of elective Caesarean surgery, particularly in tertiary care. We listed the possible health risks in short term, long term among mothers and child. Advanced maternal age, higher socio-economic status, higher educational level, residing in urban area, and ownership of health insurance were found to be factors associated with maternal choice on Caesarean delivery. The information presented is important to raise awareness among policy makers aimed to develop a national strategy in reducing the rate of Caesarean delivery.


Caesarean Section; Prevalence; C-Section Indication; Gut Dysbiosis; Synbiotic

Full Text:



Todman D. A history of caesarean section: from ancient world to the modern era. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007;47:357-61.

Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing rate in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS ONE. 2016;11: e0148343.

Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet. 2010;375:490–9.

World Health Organization. WHO Statement on Caesarean Section Rates. Geneva; 2015.

Nababan HY, Hasan M, Marthias T, Dhital R, Rahman A, Anwar I. Trends and inequities in use of maternal health care services in Indonesia, 1986-2012. Int J Womens Health. 2017;10:11–24.

Ryding EL, Lukasse M, Kristjansdottir H, Steingrimsdottir T, Schei B, Bidens study group. Pregnant women's preference for cesarean section and subsequent mode of birth - a six-country cohort study. J Psychosom Obstet Gynaecol. 2016;37:75–83.

Fuglenes D, Aas E, Botten G, Oian P, Kristiansen IS. Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear. Am J Obstet Gynecol. 2011;205:e41–9.

Eide, K.T., Morken, N. & Bærøe, K. Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth. 2019;19:102.

Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, et al. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report. 2010;30:1-31.

Souza, J., Gülmezoglu, A., Lumbiganon, P. et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010;8:71. https://doi.org/10.1186/1741-7015-8-71

Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS medicine 2018;15: e1002494. https://doi.org/10.1371/journal.pmed.1002494

World Health Organization. WHO recommendations on interventions targeted at women for the reduction of unnecessary caesarean sections. 2018.

Agency of Health Research and Development (Indonesia). Basic Health Research 2018.

TEMPO. Claim value of 3.2 T, C-section is suspected to be the cause of BPJS deficit. [Nilai klaim Rp 3,2 T, bedah cesar diduga jadi biang defisit BPJS]. Downloaded from: https://bisnis.tempo.co/read/1278744/nilai-klaim-rp-32-t-bedah-cesar-diduga-jadi-biang-defisit-bpjs/full&view=ok [May 5, 2020]

Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson-Smart DJ, Crowther CA, and The SEA-ORCHID Study Group. Caesarean section in four South-East Asian countries: reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth 2009;9:17.

Verma V, Vishwakarma RK, Nath DC, Khan HTA, Prakash R, Abid O. Prevalence and determinant of caesarean section in South and South-East Asian women. PLoS ONE 15:e0229906.

Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392:1341-8.

Agency of Health Research and Development (Indonesia). Basic Health Research 2010.

Agency of Health Research and Development (Indonesia). Basic Health Research 2013.

Royal College of Obstetrician & Gynaecologists. Birth after previous Caesarean birth. 2015. Downloaded from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

National Collaborating Centre for Women’s and Children’s Health. Caesarean Section – Clinical Guideline, April 2004. Downloaded from: http://www.csh.org.tw/dr.tcj/Educartion/Guideline/OB%20guideline/CS1%20Guideline.pdf

WHO. Robson classification – implementation manual. Downloaded from: https://apps.who.int/iris/bitstream/handle/10665/259512/9789241513197-eng.pdf;jsessionid=06F03DBB4EA7933E35B8B537FAA00B85?sequence=1

Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015;3:e260-70.

Sungkar A, Santoso BI, Surya R, Fattha ANA. Classifying caesarean section using Robson classification: an Indonesian tertiary hospital survey. Maj Obs Gin 2019;27:66-70.

Pamilangan ED, Wantania JJE, Lumentut AM. Indikasi seksio sesarea di RSUP Prof. Dr.R.D. Kandou Manado tahun 2017 dan 2018. e-Clinic 2020;8:137-45.

Saddam F, Purbawa PAA. Maternal referral at Kalabahi general hospital: a descriptive study. Indones J Obstet Gynecol 2020;8:10-3.

Andayasari L, Muljati S, Sihombing M, Arlinda D, Opitasari C, Mogsa DF, et al. Proporsi seksio sesarea dan faktor yang berhubungan dengan seksio sesarea di Jakarta. Buletin Penelitian Kesehatan 2015;43:105-16.

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 559: Cesarean delivery on maternal request. Obstet Gynecol. 2013;121:904‐7. doi:10.1097/01.AOG.0000428647.67925.d3

Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat Caesarean deliveries. Obstet Gynecol 2006;107:1226.

National Institutes of Health State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request. Obstet Gynecol 2006;107:1386-97.

Dahlgren LS, von Dadelszen P, Christilaw J, et al. Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants. J Obstet Gynaecol Can. 2009;31:808‐17. doi:10.1016/S1701-2163(16)34299-2

Jenabi, E., Khazaei, S., Bashirian, S., Aghababaei, S., & Matinnia, N. (2019). Reasons for elective cesarean section on maternal request: A systematic review. The Journal of Maternal-Fetal & Neonatal Medicine, 1–161.doi:10.1080/14767058.2019.1587407

Sihombing N, Saptarini I, Putri DSK. Determinan persalinan sectio caesarea di Indonesia (analisis lanjut data riskesdas 2013). Jurnal Kesehatan Reproduksi 2017;8:63-75.

Mascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica. 2017;51:105. doi:10.11606/S1518-8787.2017051000389

Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of venous thromboembolism after caesarean sections: a meta-analysis. CHEST 2016;50:572-96.

Darabi, B., Rahmati, S., HafeziAhmadi, M.R. et al. The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis. Allergy Asthma Clin Immunol. 2019;15:62. https://doi.org/10.1186/s13223-019-0367-9

Bardosono S, Hildayani R, Chandra DN, Basrowi RW, Wibowo Y. The knowledge retention after continuing health education among midwives in Indonesia. Med J Indones [Internet]. 2018Sep.9 [cited 2020Aug.7];27(2):128–33.

DOI: https://doi.org/10.25220/WNJ.V04.S2.0001


  • There are currently no refbacks.

Copyright (c) 2020 Ali Sungkar, Ray Wagiu Basrowi

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

View My Stats