Women are more likely to have an unplanned birth by caesarean section in a private hospital than a public one, even if they do not want or need it, a new study has found.
The study, published early this month, showed an unplanned CS birth was 4.2 per cent more likely in a private hospital than in a public one. For first-time mums, it was 7.7 per cent more likely.
Also known as C-section or caesarean delivery, it is a surgical delivery of a baby through a cut or incision made in the mother's abdomen and uterus, often performed to save the child's or mother's life.
Among young Kenyan mothers, CS seems to be winning over natural birth. Advances in medical technology, coupled with the preferences of Kenya’s growing middle class, are changing how women give birth.
The World Health Organization (WHO) notes that CS has become one of the most common surgeries in the world, with rising rates particularly in high- and middle-income countries.
In Kenya, the procedure constitutes about 8.9 per cent of all births, with a higher rate of about 16 per cent in urban areas, against the recommended 10 to 15 per cent.
Official records show that CS accounted for 44 per cent of NHIF’s maternity costs of Sh5.67 billion. NHIF data shows payments for the procedures have more than doubled over the past five years, underlining how widespread its use has become.
Globally, the procedure now accounts for more than one in five (21 per cent) of all childbirths and is expected to rise to 29 per cent by 2030.
While it can be an essential and life-saving surgery, CS can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need.
“Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed,” said Dr Ian Askew, director of WHO’s department of sexual and reproductive health and research and the UN joint programme HRP.
“But not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby.”
Changing demographics have, however, spawned an interesting trend where mothers in a lower socio-economic class give birth naturally while the middle and upper classes choose CS, even if there is no medical need for the surgery.
The choice of delivery method is often made by the mother-to-be in consultation with her doctor. In some cases, however, a CS birth is planned because of medical reasons that make a natural birth risky.
But a new study in Australia found that private doctors and hospitals are more likely to intervene in childbirth because they are employed and paid differently from their public-hospital counterparts.
Private hospitals have been accused of pushing women into CS births because the procedure generates more money for doctors and their hospitals than natural births. But it was unclear to what extent this is attributable to unobserved selection effects related to clinical need or patient preferences.
While NHIF pays out an average of Sh29,385 for a procedure, the insurer does not pay for elective CS. Top private hospitals charge more than Sh200,000 for CS compared with between Sh100,000 and Sh120,000 for normal delivery.
Using administrative birth data on over 280,000 births in Australia between 2007 and 2012, a team of researchers has established that giving birth in a private hospital increases the probability of having an unplanned caesarean birth by up to four per cent.
The researchers say doctors in private hospitals are employed and paid differently from their public counterparts, and so they face different incentives to intervene during labour and childbirth.
Private obstetricians are paid on a fee-for-service basis to attend births. By contrast, public-hospital obstetric and midwifery staff are paid a salary for agreed hours. This means that the more births private obstetricians attend, the more they earn.
The WHO says these rising rates suggest increasing numbers of medically unnecessary, potentially harmful procedures. CS births have also been linked to a range of short and long-term adverse child health outcomes, such as respiratory infection, eczema and metabolic disorder.
For pregnant women, knowing when a CS birth is truly necessary is the million-dollar question. Women want to trust the opinion of their doctors on whether they need the surgery, and in some cases, the procedure is crucial.
But the question likely to pop up in a mother’s head is this: which method is safer for both baby and mother? Women should formally have the right to choose CS births, but they must also be offered counselling to help them make their decision.
