The first-ever study into factors influencing the choice of Caesarean sections has revealed some interesting information around why doctors and clinicians push their patients to go for this option.
After seeing C-section rates rising substantially over the past few decades, often without clear rationale and limited additional maternal or neonatal benefits, and without medically justifiable reasons, researchers embarked on a study to uncover the truth behind this phenomenon.
It was discovered that almost 70% of doctors who deliver babies by C-section may do so because they're afraid of being sued. Coupled with this, some also indicate that they choose C-sections in order to avoid damage to the woman's body or because there is insufficient staff to allow for vaginal birth.
Some also said that performing C-sections is more "convenient" and "organised". All of this, despite evidence that natural, vaginal births are safer and less likely to involve complications.
An international study
Once more than 7 700 obstetricians and just under 1 200 midwives from 20 countries submitted their responses regarding the topic, the Public Library of Science One (PLoS One) published the study: Clinicians' views of factors influencing decisionmaking for Caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies.
Hailing from Trinity College in Dublin, Ireland and Sahlgrenska Academy at Sweden's University of Gothenburg, the researchers observed that about a quarter of women in the United Kingdom (UK) and a third of those in Ireland gave birth by C-section.
In South Africa, the number of C-sections is particularly high in private hospitals. Sydney Grove, a male midwife and the General Manager of the Origin Family-Centred Maternity Hospital, said that South Africa's C-section rate is lower in government hospitals than in the private sector.
A recent official review put the rate at 65%, but this has gone up to 85–90% in some private hospitals, and even 100% in some individual hospitals at particular times of the year.
"The whole drive is to decrease the C-section rate, and the World Health Organization (WHO) puts the rate to aim for at 15–20%, but I think the goal in South Africa should be not more than 25–30%.
"For example, according to our statistics at Origin Family-Centred Maternity Hospital, over the 12-month period from 1 March 2017 until the end of February 2018 our C-section rate was 35.8%. This includes planned and unplanned or emergency C-sections and those stemming from clients aiming for a VBAC (vaginal birth after Caesarean) where it ended up as a C-section.
"The gynaecologists whom we partner with deal with more high-risk cases, which also raises this percentage. Since March our rate has been around 25%," said Grove.
Practising defensive medicine
Grove added that incidences of litigation have increased and doctors tend to practice what they call "defensive medicine", where they would rather prematurely take the decision to cut (perform a C-section).
He also said that over the last few decades, nursing training has been "watered down" and doctors may find it difficult to trust midwives in the labour wards to call them in an emergency.
"Decision-making becomes very challenging for doctors if they suddenly need to make a decision on a patient in the middle of the night, perhaps working with a particular staff member or limited staff that they don't trust.
"So, quicker procedures and invasive procedures become the order of the day – and that is why we are where we are. We need more nursing staff and, in particular, midwives to be cultivated, who work at institutions where they have developed ownership for what they do," said Grove.
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