3 Things Midwives And Obstetricians Should Know About C-Section

1. The World Health Organization (WHO) recommends that the maximum C-section rate should be 10–15%, regardless of a country’s economic or health profile.

This has been a number of obstetric societies’ policy guideline for many years; yet some countries blatantly ignore it, despite publicly lauding the WHO.

2. South Africa has one of the highest national C-section rates in the world: 60-70%.

Private hospitals in South Africa often exceed this, and Caesar rates have been shown to peak before public holidays and major holiday periods like Easter and Christmas – although doctor and hospital convenience is almost never cited. There is no medical justification for such high rates, but most couples are under the impression that their C-section is necessary. The next highest national C-section rate is probably Brazil (who are however actively working to reduce this rate), followed by the USA, at about 30%.

3. South Africa is still a relatively doctor-friendly country and ‘patients’ hesitate to question medical advice, even when their gut and personal experience prompt them to.

Obstetricians are among the most heavily insured of all medical practitioners and premiums are exorbitant. Chances of litigation are reduced if interventional steps like C-sections are taken at the first hint of poor progress or anything “not quite standard”. This, despite the evidence for higher mortality and complications for mother and Baby post-Caesar, compared to natural and midwifery-led birth in the vast majority of low-risk pregnancies and labours. The medical birth model is also comfortable for many obstetricians, as their training is geared towards dealing with pathology and complications, and their exposure to natural birth is often almost non-existent.

Selective attention

Frankly, it’s unethical not to be on top of the evidence about birth or the misuse of C-section, and unacceptable that parents are often persuaded to accept premature induction or C-section using semi-truths like: low levels of amniotic fluid possibly indicating a problem, Baby’s size justifying early C-section, calcification of the placenta, and Baby not dropping into the pelvis by 36–38 weeks. Research shows that most low-risk pregnant women can give birth naturally, and the only way to tell is through trial labour.

Elective C-section ahead of the due date is a particularly contentious issue and is often the result of medical pressure – could it be that scheduled Caesars are both more convenient and economically beneficial? There is also ‘client pressure’, as many modern couples find it more convenient to choose their baby’s birth day – however, this was NOT the original driving force behind elective C-sections, and the obstetric fraternity have to take the blame for allowing it to develop.

One of the aims at birth is to have both woman and child safe and well, but a good birth is more than this! A woman who feels good about her birth finds mothering easier and has less chance of postnatal depression. For Baby, it often means better health and less need for therapies to assist milestone development.

Please, take a moment before recommending C-section; the medical model of birth doesn’t have better outcomes than midwifery-led and natural birth! Let’s halt the tsunami robbing humankind of all knowledge of what natural labour and birth really is.