A changing birth: What is behind
The way we come into the world tells a story of rich and poor — and of promise and peril
study looked at the numbers globally, they told a story of richer and poorer — as well as of progress and peril.
It’s a tale playing out right here at home.
Globally, who gets a C-section is now often determined by factors such as income and education rather than by sheer emergency. When scientists looked at data from 169 countries, caesareans were almost five times more frequent among the wealthiest people in low- and middle-income countries. Educated women in countries such as Brazil and China also often elected to have the procedure even when their deliveries were lowrisk, The Lancet study found.
In contrast, many women in lowincome and even in some middleincome countries, especially in subsaharan Africa, still don’t have access to the procedure — putting them at a higher risk of maternal death.
Almost twice as many procedures were performed in the private sector as in public health facilities, The Lancet study found.
In South Africa, about six out of 10 mothers in the private sector delivered by C-section in 2017, the Council for Medical Schemes’ annual report reveals.
Linda van Wyk* knew she wanted a caesarean section from the moment she realised she was pregnant.
“I didn’t get maternity leave so I had to maintain myself and plan carefully for the four months I was taking off work,” she says.
“I told my doctor that a C-section would allow me to meticulously schedule my daughter’s birth and work until the last moment, and she never told me that I couldn’t.”
In the public sector, there’s no single answer to why C-section rates are climbing, the national health department’s deputy director general for communicable and noncommunicable diseases, Yogan Pillay, says.
Instead, reasons lie in everything from better access to services to declining use of other methods for dealing with difficult births.
For instance, the percentage of women who delivered at health facilities and not at home rose by 26 percentage points between 2001 and 2009, a 2010 Statistics South Africa report shows.
Increased access to medical services hasn’t just increased the overall rate of C-sections in the public sector, it has also created “hot spots”.
The largest number of caesareans take place at hospitals able to provide higher levels of care — in other words — regional, tertiary or central hospitals, according to the 2015/16 District Health Barometer.
But not every district has these kinds of facilities, meaning that those that do often cater for cases referred from their neighbours, Pillay explains.
Five district municipalities have C-section rates of 34% or more: the Eastern Cape’s Nelson Mandela Bay and Buffalo City districts, as well as Amajuba, Umgungundlovu and Ugu districts in Kwazulu-natal.
“[These] are all districts with tertiary hospitals,” Pillay explains.
“These hospitals receive referrals for surrounding districts and it is expected that the C-section rates will be higher in these areas because of the more complex nature of the cases they see.”
Caesareans may also be on the rise because other traditional techniques — such as the use of forceps or vacuum suction — to help deliver babies are on the decline, he argues.
A 2018 South African Medical Journal study found that less than one percent of births happen this way, a rate researchers say is too low and probably indicative of a lack of skills, equipment or willingness to perform assisted deliveries among healthcare workers.
And more doctors are simply afraid
Almost 30-million babies will come into the world this year by caesarean — nearly double the number of infants delivered in this way almost two decades before