Cesarean section: necessity or choice?

**Cesarean section: a necessity or a choice?**

A few years ago, when pregnant women headed to the maternity hospital, their main question was "will I be able to bring my child into the world healthy and safe?" Today, however, another question has been added to this: "Will I give birth naturally or through a cesarean section?" Kun.uz has prepared a program dedicated to this topical issue. In it, with the participation of industry experts, doctors, and protagonists who have gone through this process, the reasons for the increase in cesarean section operations, its negative complications, and the new legal regulations being adopted in this regard were discussed.

Public opinion on cesarean section is not uniform. While some view it as an easy way to escape labor pain, others believe that the operation should only be performed when there is a medical necessity. Women who participated in the survey also expressed different views on this matter. Some linked cesarean section to women's inability to tolerate labor pain and choosing an easier path. Others emphasized that the operation has its own specific difficulties, but its importance is incomparable when a medical necessity arises.

"Now, of course, I think giving birth naturally is better, God did not create it this way for nothing. Giving birth naturally is still better. But an operation is still an operation. Many people are choosing cesarean now simply because they cannot tolerate the pain. Not tolerating the pain, and then many people are very delicate now, they are not strong after all. That's why they choose cesarean, they don't have the strength," said one of the women who participated in the survey.

The number of requests for cesarean section operations has been increasing in recent years. This is influenced by factors such as the development of modern diagnostic methods, the possibility of early detection of certain conditions in the fetus and the mother, as well as the increase in pregnancies through IVF. In Uzbekistan, too, this indicator has increased year by year: while cesarean section operations accounted for 20–21 percent nationwide in 2023, in subsequent years they rose to 24–26 percent. By the end of 2025, this indicator was around 27–28 percent.

Yulduz Eshonova said that cesarean section has taken on not only a medical but also a social character, with women demanding the operation of their own free will out of fear of labor pain. She noted that although the figures in the country are lower compared to world standards, they are increasing year by year.

"Here, in Turkey, you know the diagnostics, cesarean section operations account for 62 percent there. In European countries, it is 42 percent. By the end of 2025, our overall indicator in the republic will be 27–28 percent. While in 1985 the World Health Organization said 'do it from 10 percent to 15 percent', in 2015 they put forward the trend: 'No, institutions, stop, we should evaluate the surgical operation not by its percentage amount, but by the quality of its performance, at what level, and to whom it is being correctly performed, we must identify the reasons for this and try to reduce these reasons in the necessary direction,'" she says.

When it comes to healthy approaches in childbirth processes and the responsibility of doctors, the story of a protagonist who experienced the severe complications of this process in human destiny is bound to make everyone think. There are many who view the operation as an "easy way," but behind it, there are also bitter truths that arise due to medical errors and medical negligence. The protagonist who participated in the program recalls the difficult moments she experienced and the phobia left inside her as follows:

"Worse than that - I lost my sight. That was the worst part. Then, for a whole day, I did not see this bright world. Due to the anesthesiologist's mistake, they gave me too much anesthesia, meaning they overdosed it, and as a result, my twin children were left neglected without a mother's love. A pain remained in my heart, and because I lost my sight, whenever I hear about the operation called cesarean section, the phobia reappears in me. Because for me, a cesarean section is equivalent to not seeing this world. Indeed, I could not see for twenty-four hours, and additionally, an anesthesiologist came, performed a blockade, calmed me down, and put me to sleep for eight hours, and after that, my eyes started to see a bit blurry, and then I began to see well," the protagonist says with regret.

Although doctors emphasize that the operation should only be performed based on medical indications, they also point out that the insistence of some women of their own free will is a problem. Doctors also mentioned that in some cases, women change their minds after proper explanation by doctors and leave happy after natural childbirth, but when their demand is not met, they leave offended:

"In practice, if we properly explain to women who often come asking for a cesarean section, they all say happily after childbirth: 'It's a good thing you made me give birth myself.' They can stand up and walk in just two hours and easily carry their baby. After a cesarean, however, due to the abdomen being cut layer by layer, there are quite severe pains for about a month. Unfortunately, women only realize that this is not a simple operation after giving birth. Sometimes, women who come to our reception say, 'Do a cesarean section on me.' When told 'No, there is no indication for it, you can give birth yourself,' there are those who leave offended," says Dilfuza Hayitova, an obstetrician-gynecologist at the Republican Perinatal Center.

In order to prevent such problems and put an end to cases of groundless demands for cesarean section, serious measures are being taken by the Ministry of Health. Elmira Bositxonova, Advisor to the Minister of Health on Maternal and Child Health Protection, stated that new legal regulations have been adopted in this regard:

"We, the Ministry of Health, in cooperation with the Ministry of Justice, have raised the list of indications for cesarean section to the level of a regulatory legal document, and this applies to both doctors and our women. If a woman demands it even when there is no indication, she will be shown through this document: 'Excuse me, sister, you have no indication to undergo this operation,' and she must bring her child into the world through physiological childbirth. Today, disciplinary sanctions will be applied to doctors who perform cesarean section operations without indications, failing to comply with approved protocols. If this situation leads to complications, or even maternal or infant mortality, then it is clear that they will also be held criminally liable," she said.