In part III of its global survey on childbirth, the World Health Organization reports that C-sections have reached “epidemic proportions” worldwide. In 2005 the WHO surveyed hospitals in Latin America and found that where the cesarean rate had risen above 10-15%, women and babies suffered more complications and deaths. This latest survey, conducted in Asia, confirms the previous findings with data from 110,000 births. Women who gave birth by cesarean were more at risk for blood transfusions, hysterectomy, and death, and babies had higher rates of death and poor outcomes that led to extended hospital stays. “Together these findings provide strong multiregional support for the recommendation of avoiding unnecessary caesarean sections,” the authors write. “To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.”

“The relative safety of the operation leads people to think it’s as safe as vaginal birth,” Dr. A. Metin Gulmezoglu, an author of the study, told the Associated Press. “That’s unlikely to be the case.”