South African Women Are Overdoing C-Sections

Way too many women are electing to have their babies by Caesarean section, or C-sections.

Medical aids are concerned about the abnormally high number of C-sections claimed for each year. They say that few of these C-sections are medically required.

Medical scheme giant Discovery Health claims that over 70% of all deliveries paid for by Discovery were C-sections. Five years ago the figure was 50%. Bonitas reports the same trend.

In fact, the main reason for Discovery members going to hospital is for C-sections, followed by digestive tract diagnosis, whooping cough and pneumonia.

The WHO (World Health Organisation) advises a maximum of 15 percent C-sections per country. The figure for South Africa is about 70 percent in the private sector and about 18 percent in state hospitals

C-SectionsPart of the problem is the fact that in private hospitals a normal birth costs around R26 000 while a C-section is in the region of R30 000. Faced with a choice moms are deciding to have Caesareans.

Another issue is that Caesarean sections are listed under the Prescribed Minimum Benefits (PMBs) as laid down in the Medical Schemes Act, so medical aids are obliged to pay for them.

Spokesman for the Board of Healthcare funders, Heidi Kruger said while many gynaecologists say Caesareans are safer than natural childbirth, the board believes they are “not necessarily safer”. She admitted that South Africa’s high incidence of HIV/Aids was also responsible for pushing up the C-section prevalence, which, she said, should ideally be about 30%.

Kruger said it was a pity that the Health Professions Council had ruled that the method of delivering a baby was the patient’s choice, if it was medically necessary or otherwise.

Jonathan Broomberg, the CEO of Discovery Health, said that apparently convenience was one of the maid reasons for the high number of C-sections in the private space.

“We cannot explain the high number of C-sections on clinical grounds because the numbers are much higher than in public health care where only those deliveries that are clinically indicated are done by means of Caesareans.”

Bonitas spokesman, Christa van Dyk, said while they support the WHO’s guidelines on Caesareans, medical aids were powerless to micro-manage deliveries. Doctors always send a motivation letter to justify a C-section.

“The cost of C-sections has a definite influence on medical aids contributions,” van Dyk added.

Why So Many C-Sections?

The question is whether delivering baby has become a medical procedure or are C-sections chosen because they are safer? Or is it simply a case of convenience?

Dr Peter de Jong, a gynaecologist and obstetrician at C.B. Memorial Hospital, there are number of reasons for the prevalence of C-sections.

More women are choosing to have the procedure, HIV/Aids plays a role as in natural childbirth there is a risk of the baby becoming infected and also doctors fears litigation for not doing a C-section.

De Jong added that the sheer convenience of having a baby on demand was also a major factor.

Another factor was that doctors are regularly sued for not insisting on a C-section for their patients. De Jong said he had never heard of a doctor being sued for doing a C-section.

There is also the aspect of the beneficial effects of C-sections. Research had suggested that by having a C-section protected women against faecal and urinary incontinence later in life.

Balanced with all of these factors is the fact that in the public sector at least the risk of maternal death is higher in C-sections than in natural births.

Professor Rob Pattinson, director of the Medical Research Council research unit for maternal and infant health care strategies, said haemorrhaging was more common in Caesareans than in natural births and that C-sections often made subsequent births more complicated.

Professor Lynette Denny, head of obstetrics and gynaecology at UCT and Groote Schuur, agreed with Pattinson and said while C-sections in state hospitals were usually done for good medical reasons in the interests of mother and child, the private sector was another matter.

Some reasons for high C-section incidences in the private sector were convenience for the doctor and for the mother and the monetary incentives for the private hospitals. She did not accept that C-sections were necessarily safer. In fact, she said, an unnecessary C-section was 10 times more life-threatening than a natural birth.

Prof Denny went further, saying, “Women are fooled into believing that a Caesarean is quicker, easier and a more healthy procedure than normal vaginal birth. That is untrue.

“In my opinion, unnecessary C-sections are bad practice and an assault on women and their babies. They should be discouraged at all costs. Most women are capable of delivering vaginally and unless medically indicated this is the best way for them to have their babies,” she said.

Professor Gerhard Theron, head of the Department of Gynaecology and Obstetrics at Stellenbosch University, said that as deliveries of babies in private hospitals were still doctor-managed and not nurse-managed, the rate of C-sections was likely to remain high. Theron said doctors did not have the time to tend to a woman in labour all the time.

Prof Theron said that Denmark, Sweden, Norway and Holland had kept C-section rates low – between 18% and 20%. Normal deliveries were carried out by trained midwives. Doctors only became involved in abnormal births.

He added that women should empower themselves to make their own decisions about the birthing procedures and not allow doctors to decide for them. Women could demand to have a normal birth if there was no medical reason for a C-section.