Mom’s choice, not doctor’s
complications … Nobody is sued for an unnecessary Caesarean section. Only if things turn sour, as sometimes it would, with any medical procedure,” he says.
“Gynaecologists are being accused of having only their own interests at heart. But nothing could be further from the truth.”
Patti Good, founder of My Birth My Choice, a group that promotes making empowered birth choices, says “the fear of being sued or not being able to pay for your medical insurance is not a valid reason to suggest C-sections for mothers who are able to and want to deliver vaginally”.
“The system may be against doctors, but this should not become the burden of their patients,” she says.
Doctors are obliged to disclose the risks and benefits of C-sections and vaginal births to their patients, so that they can make an informed decision while exercising their right to choose between the two options.
The chances of complications arising during an elective C-section are four to eight times lower than when one has an emergency C-section, says Swart. A prolonged labour or complication during labour often results in an emergency Caesarean section.
Not all C-sections result in a safe delivery for mothers and babies. A 2011-2013 report commissioned by the health department, titled Saving Mothers, says bleeding during or after a Caesarean section was responsible for a third of the maternal deaths that took place in South Africa’s public health sector. Many women died as a result of poor surgical skills in some hospitals, a delay in recognising internal bleeding and nurses and doctors responding too late to a mother’s deteriorating vital signs.
In public facilities, most Caesarean sections are performed in district or regional hospitals, according to the department of health’s 2012-2013 Saving Babies report. There are 42 regional hospitals in South Africa and they each perform an average of four Caesarean sections a day. The 188 district hospitals each perform one Caesarean section a day for an average of 2 000 births each year.
“The rate at which a hospital performs C-section births depends on what kind of hospital it is. For example, our Caesarean section rate at Steve Biko Academic Hospital is way above 50%, which is expected because it is a level-three hospital where lots of complicated cases are referred,” says Swart.
The World Health Organisation says national Caesarean section rates higher than 10% do not reduce maternal and newborn deaths. The C-section rate in South Africa’s private hospitals is almost seven times higher than this.
Good says the high Caesarean section rate in South Africa is because women are not informed enough about different birthing options and gynaecologists do what is most convenient for them.
“Every woman has to have a gynaecologist but can have additional support in the form of an independent midwife or doula … Mothers need to acknowledge that their physical needs are the responsibility of their gynaecologists, but their emotional and mental needs should be taken care of by themselves or having an independent midwife or doula.”
Six years after the birth of her daughter, Van Wyk is watching her draw a picture of a dolphin. She says the painkillers her doctor prescribed helped her cope with the pain of the surgery. Although she could not drive for six weeks, she was able to lift her baby by herself after being discharged.
“If I could go back, I would do it again,” she says and passes a crayon to her daughter.
Good says doctors must take the emotional and medical wellbeing of pregnant women into account.
Ultimately, it is about what the mother thinks is best for her and her baby.
“It is not about Caesarean section birth versus natural birth. It is about hiring a practitioner who supports your choices, then becomes key to having a better birth. This is also about making sure that there is enough information for mothers, so that they are informed when they make this choice.”
* Not their real names