Karachi: A growing number of Pakistani gynaecologists are urging women, particularly first-time mothers, not to opt for Caesarean section unless it is medically necessary, warning that the country’s rapidly rising C-section culture is fuelling a dangerous placenta disorder in subsequent pregnancies that can cause life-threatening bleeding, force removal of the uterus and, in many cases, permanently deprive women of their ability to have more children.
The placenta is a temporary organ that develops inside the uterus during pregnancy and serves as the baby’s lifeline, supplying oxygen and nutrients while removing waste products. Although it is naturally expelled after childbirth and is routinely discarded as biological waste by hospitals, doctors say it is one of the most important organs during pregnancy and can become life-threatening when it fails to separate from the uterus after delivery.
The condition, known as Morbidly Adherent Placenta, or nowadays referred to as Placenta Accreta Spectrum (PAS), occurs when the placenta grows abnormally deep into the wall of the uterus instead of attaching normally to its surface.
Instead of separating naturally after the baby is delivered, the placenta remains firmly attached to the womb, causing severe haemorrhage. In many cases, doctors have no option but to remove the uterus to save the mother’s life, permanently ending her ability to have future pregnancies.
“I am seeing an increasing number of cases of morbidly adherent placenta, which is why I now advise young women, particularly those having their first baby, not to choose Caesarean section unless it is absolutely necessary for the safety of the mother or child,” said Dr Afshan Shahid, a senior gynaecologist associated with Dow University of Health Sciences, Karachi.
She said many women opt for C-section because of fear of labour pain, convenience, or pressure from families and, in some cases, private healthcare providers, without being adequately informed about the long-term reproductive risks.
Doctors explain that every Caesarean section leaves a scar on the uterus. During subsequent pregnancies, the placenta may implant over this scarred area. Because scar tissue lacks the normal biological characteristics of healthy uterine tissue, the placenta can invade too deeply into the womb, dramatically increasing the risk of catastrophic bleeding during delivery. Such cases often require highly complex surgery, multiple blood transfusions and intensive care support.
Although Pakistan lacks a national registry for Caesarean deliveries, data from public and private hospitals, particularly in major cities, suggest that between 50 and 70 percent of births in some urban and private-sector facilities are now delivered by C-section. Clinicians say these rates reflect a worrying departure from medically indicated obstetric practice and are considerably higher than those reported in many countries in the region.
The World Health Organization (WHO) has repeatedly warned that increasing Caesarean section rates do not necessarily improve maternal or newborn outcomes. According to WHO, C-section rates above about 10 percent at the population level are not associated with further reductions in maternal or newborn mortality, while unnecessary surgery exposes both mothers and babies to avoidable short- and long-term health risks.
Senior gynaecologist Dr Samrina Hashmi said previous uterine surgeries are the strongest factor driving the increase in morbidly adherent placenta cases.
“Procedures such as C-sections, fibroid surgeries, repeated dilatation and curettage, and other intrauterine procedures leave scars that lack the normal biological signals of healthy uterine tissue,” she explained. “With each additional C-section, the uterus becomes more vulnerable to abnormal placental attachment in future pregnancies.”
She said that among women with placenta previa, the risk of morbidly adherent placenta rises sharply with repeated Caesarean sections. “With two previous C-sections, the risk can reach around one in ten, while after four Caesarean deliveries it can exceed 50 percent,” she said, warning that many young women in Pakistan undergo multiple C-sections before the age of 30.
Other senior gynaecologists have also linked the growing burden of complex obstetric complications to gaps in surgical training and supervision. Dr Sadia Ahsan Pal, a Karachi-based obstetrician and gynaecologist, has highlighted in her academic work that structured surgical mentorship has weakened over time, with many young doctors learning operative techniques in overstretched hospitals without adequate supervision.
Experts warn that poor surgical technique can increase uterine scarring, further compounding the long-term risks associated with repeat Caesarean sections.
Dr Syeda Batool Mazhar agreed that while Caesarean sections are life-saving when medically indicated, their overuse has become a serious public health concern. She stressed the need for better counselling of expectant mothers, stricter adherence to clinical guidelines and greater accountability in maternity care, particularly in the private sector.
Doctors say managing morbidly adherent placenta requires early diagnosis, multidisciplinary surgical teams, experienced obstetricians, reliable blood banks and intensive care facilities, resources that remain scarce outside Pakistan’s major urban centres. They warn that unless unnecessary Caesarean sections are curbed today, Pakistan could face a growing burden of preventable maternal deaths, emergency hysterectomies and pregnancy-related complications in the years ahead.
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