ABU DHABI // Women having babies later in life, a culture of having large families and misconceptions about the surgery are contributing to Caesarean sections in the UAE being performed at almost double the global recommended rate.
According to the World Health Organisation’s 2015 World Statistics Report, a quarter of all births in the Emirates are c-sections, well above the medically necessary target of between 10 per cent and 15 per cent that the WHO says is ideal.
Paul Bosio, chief medical officer at Corniche Hospital, said every time a c-section is performed the uterine wall is weakened – increasing the risk of uterine rupture, which can be life-threatening for mother and baby.
The more children a women has, the higher the likelihood that she will need a Caesarean section. Once she has one c-section she is much more likely to have a Caesarean in future births, he said.
“It is not unusual for us to see three, four, five, six c-sections,” Dr Bosio said. “It is a huge problem in Abu Dhabi.”
The most important message, he said, was to try to avoid the first c-section unless absolutely necessary.
“To do that you need good monitoring and the highest effect on a low Caesarean section rate is continuous support during the labour, primarily and preferably by a midwife,” he said.
Dr Bosio said it was important to put the WHO figures in context. No developed country has the rate the WHO recommends – which Dr Bosio says is “very aspirational”.
The United States, for example, has about a 33 per cent rate of c-sections.
“This is not a UAE phenomenon,” Dr Bosio said.
While in some parts of the developed world some may elect a c-section because they feel it will minimise pain or certain complications, Dr Bosio said this was not the case in the UAE.
“They by and large prefer to have natural births,” he said.
Dr Razia Sharafudeen, a specialist obstetrician and gynaecologist at Brightpoint Royal Women’s Hospital, agreed.
“While some women opt for surgery over natural delivery because they fear the pain of childbirth, Emirati women are not known to request the procedure for these reasons,” she said. “Instead, it is the age at which women have their first babies, and well as increasing maternal BMIs, which are the main contributing factors for rising c-section rates in the UAE.”
Financial incentives also contributed to the rise, she said.
“With hospital bills for Caesarean births being much higher than those related to vaginal births, this offers some hospitals a compelling reason to recommend Caesareans as it increases the scope for profit,” she said.
Dr Gowri Ramanathan, head of obstetrics and gynaecology at Danat Al Emarat Hospital, said the number of Caesarean sections were increasing, particularly in the past few years.
“About 20 years ago, the rate was around 5 per cent; 10 years ago it was around 10 per cent and now it averages 30 per cent or so in Abu Dhabi,” she said.
Dr Agatha Moniz, a gynaecologist at Dubai’s Medcare Hospital, said while many mothers have to have birth by Caesarean – such as those women who have gestational diabetes and consequently the baby is too big to pass safely through the birth canal – there are those who choose a c-section over a vaginal delivery for no medical reason. “Those who want an elective c-section may be afraid of the information they have regarding normal delivery,” Dr Moniz said.
Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby – for example due to prolonged labour or foetal distress, however, like any other major surgery, c-sections can have complications, like internal bleeding, blood clots or infection.