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China should return to the natural birth model

by Cesar Chelala

The long-expected birth of a boy to the Duchess of Cambridge and Prince William — through a natural birth procedure — is a good opportunity to ponder the high number of Caesarean births (C-sections) practiced in China.

The situation has reached epidemic proportions, and some of its serious consequences should make Chinese women think twice before requesting this procedure. Today, China has one of the highest rates of C-sections in the world, estimated at 46 percent in 2007.

There are several cases of the use of this technique in ancient history. Luzhong, a sixth-generation descendant of the Yellow Emperor, had six sons, all born by “cutting open the body.” Jilian, the sixth son, founded the House of Mi that ruled the State of Chu.

The view that a woman has the right to make decisions regarding her body and her health has led many of them to make a choice regarding the method chosen to give birth. And increasingly throughout the world, women have been demanding to have their children born through a Caesarean section.

In this regard, a Caesarean delivery on maternal request (CDMR) is a movement that may have started in Brazil, one of the countries with the highest number of Caesarean born children.

The choice of this procedure, however, carries some health risks, warns the World Health Organization, which doesn’t see the advantages of the shift from vaginal birth to Caesarean birth.

In a survey of nine Asian nations, WHO found that unnecessary Caesarean sections are costlier than natural births and raise the risk of complications for the mother.

Many experts still insist that natural birth is the ideal way. “The relative safety of the operation leads people to think it is as safe as vaginal birth,” said Dr. A. Metin Gulmezoglu, who co-authored the Asia report, “but that’s unlikely to be the case.”

WHO, which reviewed nearly 100,000 births across Asia in 2007-2008, found that 27 percent were done by Caesarean section, apparently at mothers’ request and encouraged by hospitals eager to make bigger profits.

Slightly higher results were reported by WHO in a study conducted in 2005 in Latin America, which found that 35 percent of the women surveyed delivered their babies by Caesarean section.

In Europe, there are big differences among countries: While in Italy the Caesarean section rate is 40 percent, in the Nordic countries it is only 14 percent.

There are several reasons why women in Asia prefer to have their babies by Caesarean section. Many women fear the pain of natural birth or worry that their vaginas may be stretched or damaged by a normal delivery.

Others, however, believe that this procedure is less risky for the mother. And some women choose surgery for their delivery after consulting fortunetellers for “lucky” birthdays or time of the day to have the procedure performed.

Many experts in Latin America have warned about the abuse of the Caesarean section, particularly in countries such as Brazil, where it has reached extremely high levels. Many expectant mothers in Latin America even schedule their surgery to avoid giving birth during special holidays and even in some cases to make them able to attend some parties.

The hospitals financial profit may also be behind the abuse of Caesarean section. For example, in China’s larger cities a Caesarean can cost up to twice the cost of a natural birth. According to WHO study, 62 percent of hospitals in Asia that were surveyed reported having a financial interest in performing Caesarean sections.

In China, abuse of Caesarean births may give rise to some specific problems related to the health care delivery system.

For example, they may provoke an increased demand for hospital beds, anesthesiologists, operating theaters and laboratory and blood transfusion facilities, in detriment of more serious cases deserving attention.

In addition, a study published in Obstetrics and Gynecology found that women who had undergone several Caesarean sections were more likely to have problems with later pregnancies.

According to some experts, the introduction of the one-child policy in 1979 may have contributed indirectly to the increase use of this technique.

They claim that because the risk is lower when there are fewer repeat Caesarean sections, parents who expect to have only one child may choose what they believe is the safest option.

However, very little is known about the safety of Caesarean section in China, in spite of the fact that such information is much needed.

More studies are now needed in China on the reasons women may choose Caesarean births, an analysis of their consequences on the health of the mother and the child and the promotion of midwifery-led maternity care models that emphasize natural birth.

Cesar Chelala, M.D. and Ph.D., is an international public health consultant and the author of “Maternal Health.” He is also a co-winner of the Overseas Press Club of America award.

  • http://www.electivecesarean.com/ Pauline Hull

    Re: “In a survey of nine Asian nations, WHO found that unnecessary Caesarean sections are costlier than natural births and raise the risk of complications for the mother.”

    I would urge readers to look at the study themselves and see if they agree with the authors’ conclusion

    A link to the study itself, plus two articles written by the then Director of Straight Statistics in the UK (who concluded that the study is “a classic illustration of White Hat bias” and “the findings should be ignored”) can be found below:

    1. http://cesareandebate.blogspot.co.uk/2010/01/funny-figures-from-who-on-caesareans.html

    2. http://cesareandebate.blogspot.co.uk/2010/01/bad-case-of-bias-against-caesareans.html

    3. http://cesareandebate.blogspot.co.uk/2010/01/study-advises-against-non-medial.html

    Furthermore, in a book I co-wrote with Dr. Magnus Murphy, we include a chapter that takes a very close look at caesarean rates in China, and why so many women are choosing this birth plan. The idea that women who WANT a caesarean should be somehow encouraged or forced to have a trial of labor – and especially on the back of biased studies – is in my opinion unethical.

    One last point. Readers may be interested in the findings of this Japanese study, which found better health outcomes for babies with an increased caesarean rate:
    http://www.hindawi.com/isrn/obgyn/2013/863282/

  • JayBee

    It’s 2013. Women have come a long way. They don’t need people telling them how to give birth. Her body, her baby, and her choice. If a woman makes an informed decision to have a c-section then that is her prerogative. A cesarean certainly has risks and it is good to discuss those. However, a vaginal birth also has risks and they often get underplayed. Vaginal births can cause women to suffer from severe perineal tears, obstetric fistulas, sexual dysfunction, incontinence, anal sphincter injuries, and pelvic organ prolapse. The risks to the baby include asphyxia, brain damage, shoulder dystocia, erb’s palsy and other birth injuries caused by instruments such as forceps.

    A planned c-section at 39 weeks of gestation is a perfectly safe birth plan for a woman planning on a small family (as most women in China are).

    • some0779

      “Her body, their baby, and her choice”
      - There you go, Ive corrected it for you.
      Its absolutely the mothers choice how she gives birth. However The baby doesnt ‘belong’ only to the mother. Bother parents have equal rights and responsibilities. Courts in some countries may not rule in this way but morally, a baby does not belong ‘only’ to the mother. Either men are equally responsible for creating and then caring for a child or they are not.

      • JayBee

        Most parents do make childbirth decisions together, so I don’t think we have a problem. If there is a disagreement, then the mother will decide how to give birth since she ultimately has to do it and deal with the impact on her body and health. But yes, of course I agree that the baby is the responsibility of both parents.