ABU DHABI // Expectant mothers are putting their life and the health of their unborn child at serious risk by choosing to have repeat caesarean sections, doctors warn.
Obstetricians believe women are opting for surgery over natural delivery because they fear the pain of childbirth – with C-section rates at one Dubai hospital almost double the global recommended figure.
But with each C-section that an expectant mother undergoes, the risk of complications increases. Those risks include haemorrhaging, loss of the uterus and even death, experts say.
“There are women asking for [C-sections], mainly because I think they are not well informed or they are afraid to have the pain,” said Dr Raquel Martinez Del Olmo, a specialist in obstetrics and gynaecology at Al Noor Hospital’s Khalifa Street branch.
“They think it is going to be a long and painful process. But if we increase the number of C-sections, we are increasing the risk, especially if they plan to have more pregnancies.”
A C-section involves major abdominal surgery and increases the risk of maternal injury and death, said the 46-year-old Spanish expatriate. “The surgery itself increases the risk of infections, thromboembolic events, heavy bleeding, hysterectomy,” she said.
Post-caesarean complications include infections of the uterus or urinary tract.
“We also have to consider that every time we do a C-section we are weakening the uterine wall and that is going to interfere in future pregnancies,” said Dr Del Olmo.
This includes an increased risk of uterine rupture, which can be life-threatening for mother and baby. “That is really serious,” she said. “Every time you open the abdominal wall you are going to have a higher risk.”
While a C-section can save the lives of mothers and babies when performed in an emergency, a healthy mother should not be electing to have this surgery over a natural delivery when it is medically unnecessary. “There must be a strong medical reason to go to a surgery room,” she said.
As well as the risks to the mother, elective C-sections increase risks to the infant of premature birth and respiratory distress syndrome. Dr Del Oma said guidelines suggested that a woman should have no more than three C-sections.
Ultimately, however, it was a woman’s right to choose, she said.
The World Health Organisation has recognised an increase in recent years of C-sections without medical need. In 2010, it said the incidence rate of complications was three times higher with C-section deliveries than with natural births.
Dr Muna Tahlak, chief executive of Dubai Health Authority’s Latifa Hospital, said it was always better to opt for a normal delivery unless for medical purposes.
“The risks are adhesions, injuries to internal organs and to the placenta,” she said.
Of the 5,979 babies born at Latifa Hospital last year, 1,634 were delivered by C-section. Dr Tahlak believes some women chose a C-section simply to avoid pain.
The WHO states that no region in the world is justified in having a C-section rate greater than 15 per cent – but Latifa Hospital rates were at 27 per cent last year.
Dr Tahlak said doctors could intervene by advising mothers about the potential health risks.
Dr Pauline Hobeika, a specialist in gynaecology at RAK Hospital, agreed.
“If there is no medical need, one must try for natural delivery,” she said, pointing to a recent case where a patient suffering with a hernia was taken to the hospital’s emergency department with her intestines exposed. She had had several pregnancies and four C-sections, making her abdominal walls very weak and prone to this condition.
“Mothers choose C-sections due to lack of information. Also, most of them are afraid of the pain they may have to bear during the delivery and the changes post-delivery.”
Dr Karim Elmasry, chief of gynaecological oncology at Mafraq Hospital, Abu Dhabi, said one of the biggest problems repeat C-sections can cause is a life-threatening condition during pregnancy where the placenta grows into or through the uterus.
“The risk increases substantially with multiple C-sections,” he said.