Karachi: A growing number of Pakistani gynaecologists are urging women, especially first-time mothers, not to opt for Caesarean section unless it is medically unavoidable, warning that the country’s rapidly rising C-section culture is fuelling a dangerous and potentially life-threatening complication in later pregnancies that can cost women their lives and, in many cases, their ability to have more children.
The condition, known as morbidly adherent placenta, medically referred to as placenta accreta spectrum, occurs when the placenta grows abnormally deep into the wall of the uterus and fails to separate normally after childbirth.
In simple terms, instead of detaching on its own once the baby is delivered, the placenta becomes stuck to the womb, leading to severe bleeding. In many cases, doctors are forced to remove the uterus to save the mother’s life, permanently depriving her of the ability to bear children in the future.
“I am seeing a rising incidence of morbidly adherent placenta these days, which is why I now advise young women, especially those having their first child, not to opt for Caesarean section unless it is absolutely necessary for the safety of the mother or the baby,” said Dr Afshan Shahid, a senior gynaecologist associated with Dow University of Health Sciences in Karachi.
She said many women opt for C-section due to fear of labour pain, convenience, or pressure from families and private healthcare providers, without being properly informed about the long-term reproductive risks.
Doctors explain that each C-section leaves a scar on the uterus. In subsequent pregnancies, the placenta may implant over or into this scarred area. Because scar tissue does not behave like normal uterine tissue, the placenta can grow too deeply into the womb, becoming dangerously adherent and increasing the risk of massive bleeding during delivery. Such cases often require complex surgery, multiple blood transfusions, and intensive care support.
Although Pakistan does not have a central registry for Caesarean deliveries, data from several public and private hospitals, particularly in major cities, indicate that around 50 to 70 percent of deliveries in some urban and private sector facilities are now being conducted through C-section, a level that clinicians say reflects a worrying shift away from medically indicated childbirth practices. Public health experts warn that such rates are far higher than what is seen in most countries in the region.
The World Health Organization has repeatedly warned that rising C-section rates are not translating into better maternal or newborn outcomes. WHO says that at the population level, C-section rates above around 10 percent are not associated with further reductions in maternal and newborn deaths and that unnecessary surgical deliveries expose women and babies to avoidable short- and long-term health risks.
Senior gynaecologist Dr Samrina Hashmi said previous uterine surgeries are the strongest driver behind the surge 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 who develop placenta previa, the risk of morbidly adherent placenta rises sharply with repeated Caesarean sections. “With two prior C-sections, the risk can reach around one in ten, and with four prior surgeries, it can exceed half of all cases,” she said, warning that many young women in Pakistan are undergoing multiple C-sections before the age of 30.
Other senior gynaecologists have also linked the rising 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 writing that structured surgical mentorship has weakened over time, with many young doctors learning operative skills in overstretched hospitals without adequate supervision.
Experts warn that poor surgical technique can increase uterine scarring, compounding the long-term risks associated with repeat C-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, enforcement of clinical guidelines, and greater accountability in maternity care, particularly in the private sector.
Doctors say that managing morbidly adherent placenta requires early diagnosis, highly skilled surgical teams, and the availability of blood products and intensive care facilities, resources that remain limited outside major urban centres. They warn that without curbing unnecessary C-sections today, Pakistan risks facing a growing wave of preventable maternal emergencies in the years ahead.
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