Name: Two doctors fight to stop the global C-section epidemic
Uploaded: 2025-12-14T08:04:19.374Z
Duration: 11 min 54 s
Description: C-sections have tripled globally, and the WHO warns many are risky for mothers and babies. Two doctors in Germany are doing their part to prevent some unnecessary surgeries by helping breech pregnancies become vaginal births.

C-sections have tripled globally, and the WHO warns many are risky for mothers and babies. Two doctors in Germany are doing their part to prevent some unnecessary surgeries by helping breech pregnancies become vaginal births.

Berlin

The global rate of cesarean sections has tripled in the past 35 years, with many procedures considered medically unnecessary. In Germany, one in three births now involves a C-section, prompting concern among healthcare professionals. Obstetricians Larry Hingsen and Patricia Wanderwolle are working to reduce preventable C-sections by offering alternatives such as external cephalic version (ECV) for breech babies and by improving training for doctors in vaginal delivery techniques.

Hingsen's gentle ECV method has a high success rate and is attracting women from around the world, while Wanderwolle's initiatives at her hospital have significantly lowered C-section rates through dedicated obstetric teams and regular training. Both doctors emphasize the importance of structural changes, increased expertise, and better information for expectant mothers to further decrease unnecessary surgical births.

Two doctors fight to stop the global C-section 'epidemic'

C-Sections have tripled worldwide in the last 35 years. Also here in Germany, one in three children is now born via surgical intervention. Many of these procedures aren't really necessary from a medical standpoint. But you can't call them elective surgeries either. I think there's a big difference between a planned procedure and one that has to be done in a more stressful situation. Some experts are calling it a global C-section epidemic. We are going to show you some of the efforts being made to tackle it. Let's look at how these solutions work and explore some of their limitations too. Ultimately, all studies agree that for both mothers and children, an uncomplicated vaginal birth is best. The problem is that we can't predict which births will have complications and which won't. First, let me be clear. We are not talking about emergency cesareans. Nor are we talking about elective surgeries, when women choose to do the procedure for personal reasons, fully informed about the risks and consequences involved. We are talking about ways to reduce the C-sections that could be prevented, with the right expertise. Meet Jorinne Weide. I always imagined I'd have children one day. And we've been very lucky. We've had two healthy kids who are fine, who are doing well. And they definitely made us think about having another one. I had a very pleasant early pregnancy, thank God, which has been uneventful up to now. And now the third birth is just around the corner. How do you imagine it? I imagine it will be a peaceful, complication-free birth. Or at least that's what I hope. The current situation is that the baby is breech. And that is a birthing position that makes things a bit more complicated. Babies can get pretty acrobatic in the womb during pregnancy. Most end up with their heads pointed down, an ideal position for both mother and child. But in about 4% of cases, babies remain head up in what is known as the breech position. These days, most breech babies are delivered by cesarean section. The Charité in Berlin, one of the largest university hospitals in Europe. Jorinne has an appointment in the obstetrics department here today. She had her first child via c-section, then her second vaginally. Jorinne says the experiences differed dramatically. What scares you about having a c-section? I was open to it. But I have to say, I was surprised at how much it took out of me. Even as a young, healthy woman, I had some complications. And afterwards as well. So it's really not something I take lightly. In most cases, vaginal birth is still a possibility with breech babies like Jorinne's. But many doctors lack the experience to help women do it safely. That's why they prefer performing a c-section. In an effort to curb this trend, the WHO has published some guidelines in 2018. It warned that unnecessary c-sections offer no significant benefit. On the contrary, there's evidence that due to the risk involved, it may even harm the woman, the child and future pregnancies. In the case of a breech baby like Jorinne's, the WHO recommends performing an external cephalic version, or ECV for short. It's a procedure in which the baby is manually turned so the head is facing down rather than up. So your solution to avoid another cesarean is to have an external cephalic version performed here? Exactly. I'm trying to exhaust all available options to avoid a c-section. Yeah, my name is Larry Hingsen. I'm one of the consultant obstetricians working at the Charity University Hospital here in Berlin. How many babies did you deliver? I don't keep an exact track of all the babies that I deliver, but it's quite a lot. Larry says that over the years, he's watched a rising rate of cesarean sections in Germany and around the world with concern. That's why he wanted to provide women who want to have a vaginal birth with another option. In almost 30 years as an obstetrician, he has performed more than 1,000 ECV procedures. The breech presentation is only a part of the reasons why I'm doing it. The breech presentation is only a part of the reasons why there's a rising rate of cesarean sections worldwide. But it's also one of the areas that we can focus on to try and bring the rates down. So how do you help patients with breech babies like Urine Divider, for example? When I see them, we basically speak about three things. One is a natural delivery with breech. The option of having the baby turned. And then the third option is the cesarean section. Women from all over the world come to Larry specifically to have their babies turned. That's because he has developed a special ECV technique that takes advantage of the baby's natural reflexes. Very nice blood flow. The heart is beating. We know exactly how the baby is lying. ECV is a process with a low level of risk and a high success rate. It could provide a safer alternative to C-sections, especially in countries where poor medical care during labour and delivery is the rule. The method has been in use for about 2,000 years. But in the past, women described the manual procedure as very painful and stressful. And that's not good for either mother or child. Larry encourages the baby to move without using aggressive force. He says his gentle approach works in around two out of three cases. A very active child. Larry believes that his approach explains the rising success rates he sees. A gentle approach to ECV can prevent women from eventually having an unwanted cesarean section. But the likelihood that an emergency C-section, vacuum or forceps delivery might have to be performed is slightly higher than in deliveries where babies don't need turning. And Larry admits there are a few contraindications and rare risks associated with ECV as well. If you're going to do something like a manipulation on the baby, you want to be 100% sure that it's safe and that you've had a proper look at all the structures within the pregnancy. Not only the baby, its position and weight, but also the structures around. So how much fluid is around, where's the umbilical cord, it's very important. Because if it's wrapped around the neck several times, it could be difficult to turn and also be a high risk for stress during the external cephalic fusion. Larry says that's exactly what he wants to avoid. We also met up with another obstetrician. One who's working to overcome not only the medical obstacles that lead to preventable C-sections, she also focuses on the structural and social reasons they happen so often. Not far from Cologne's famous cathedral is the Potsdam Rhein Hospital. Patricia Wanderwolle has been working on her vision of good obstetrics here for the past 17 years. Unlike in most German hospitals, obstetrics is a separate department in the Potsdam Rhein. Patricia made this change so that a team of doctors could be available just for the delivery room around the clock. She also introduced regular training sessions on how to handle complications. You can also practice what's called shoulder dystocia, which means that the baby's head is born, but the shoulders are stuck. Then the baby can't get out. Patricia thinks many doctors choose to perform cesareans because they have too little experience with vaginal childbirth. The training helps young doctors in particular get past the fear of complicated birth and keeps them from reaching for the scalpel too quickly. Everything went well, everything's fine. Then the child can go straight to mama. There are complications sometimes during labor. Of course, you can't deny or negate that. But there are rarely factors where you say you have to have a cesarean section because otherwise the birth is too dangerous for the mother or the baby. Patricia says she's managed to reduce the cesarean rates at her clinic by over 100 procedures every year. Does the way in which you've set up your clinic help solve the problem? I think it's the beginning of a possible solution. But ultimately there are a lot of factors, more structural, organizational things, which will prove much more important. Patricia admits there are other limitations too. She thinks the way the media portrays these sections and how they are perceived in society also play roles. You're pushed into the OR and everyone is smiling and in a good mood. Then you're pushed back out with your baby in your arms. Unfortunately, it's not like that. Providing a lot of information, putting perceived risks into perspective and taking the fear out of vaginal birth. That's how Patricia builds relationships with pregnant women. Through trust and clinical care, but also by having faith in the women themselves. Even a beautiful birth is accompanied by pain and great physical effort. I don't want to trivialize it at all. That's how it is. But a woman can do it. However, women also have to be able to mentally accept that they can do it. And if there are complications, we're there to help. Jorinda's solution was accepting Larry's help. And it worked. Just a few weeks later, Jorinda gave birth vaginally without any complications. This is wonderful. I feel great about it. But I would feel even more happier if more doctors would try and learn this technique. We need more staff. We need more specialized doctors so that we can provide adequate care for women. And I'm really certain that this would allow us to avoid more C-sections. And above all, women would be more satisfied than they are now. There's still work to do. But despite limitations, dedicated healthcare professionals like Larry and Patricia continue to look for solutions for women who want more childbirth options.

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