It was a July evening and Khawla Al Naeemi was busy preparing herself – mentally and psychologically – for the arrival of her baby. Then, hours before the expected birth, the 20-year-old was given unexpected news by her doctor.
“You need a Caesarean section,” the obstetrician told her.
Throughout the pregnancy, Mrs Al Naeemi says, she was assured by her hospital in Abu Dhabi that she would have a natural birth.
“Imagine a few hours before the labour, I was told about the C-section,” she says. She recalls the day clearly. “My doctor would come, then she would send another doctor to check on me. After a few minutes, another one would follow. The cycle went on and on.”
Mrs Al Naeemi says she was so tired by the final stages of her pregnancy that she felt she had no choice but to sign the consent form for the surgery. She felt pressured by the doctor, but says she was not told at the time why she needed a C-section.
It turned out, she says, that the doctor had to attend a conference in Europe the following day. “She cut my stomach at night and travelled in the afternoon. C-section was more convenient and less time consuming for her.”
The doctor’s behaviour, she says, left her disgusted.
Five weeks after giving birth, Mrs Al Naeemi’s doctor contacted her via the messaging service WhatsApp to offer her an explanation for the last-minute Caesarean section.
“She told me that my womb is like a heart and would explode if I gave birth naturally,” she says. “Couldn’t she have told me earlier?”
Her experience has convinced Mrs Al Naeemi that C-section deliveries are often the result of business as much as medical decisions. She believes that doctors like hers are the reason for the country’s rocketing C-section rate.
The figures certainly show that the UAE has a higher-than-normal number of such births. While the World Health Organisation has a target of 15 to 20 per cent for Caesarean sections for any region, here it is more than double that.
Dr Anselma Ferrao, an Ob/Gyn consultant and medical director at Abu Dhabi’s BrightPoint Women’s Hospital, says that in some private hospitals in the UAE about half of all pregnant women have Caesarean deliveries.
Based on her experience of working in local hospitals for about 20 years, Dr Ferrao says the high rate in private medicine is not because there are so many high-risk patients.
Some doctors, she says, opt for C-sections because it is more convenient for them. In other cases, it is because the mother wants to give birth at a time that suits her. Doctors give in more easily to such demands in private hospitals, she says.
In the public health sector, doctors are only meant to perform emergency Caesareans if the mother’s life or that of the unborn child is in danger. Doctors in these hospitals are also encouraged to educate mothers and discourage unnecessary surgery, Dr Ferrao says.
The cost of a Caesarean ranges from Dh15,000 to Dh18,000, she says, depending on the hospital. “I personally avoid performing C-sections if not medically shown,” she says.
Dr Ferrao agrees with Mrs Al Naeemi about the motives of some doctors who push for Caesarean deliveries. But both hospitals and patients can take steps to cut down on the increasing rate of such deliveries, she says.
Dr Ferrao previously worked at the New Medical Centre in Abu Dhabi, which uses an on-call system to make sure doctors are available day and night for deliveries. “If a woman didn’t deliver on time and the doctor finished her duty, another doctor would take care of her until she delivers naturally,” she says. “This is the reason the rate was very low in NMC.”
Now BrightPoint has introduced its Hala Baby programme, which offers educational, coaching and training sessions for pregnant women.
The programme, among the first of its kind in the region, is designed to educate expectant mothers on everything from pregnancy to labour through to breastfeeding. “Through applied knowledge, we empower women,” says Rima Al Khatib, the nursing supervisor of Hala Baby. The programme was inaugurated four months ago and so far Mrs Al Khatib has seen 94 patients.
“I have 18 years of experience in the field of nursing,” she says. “I have worked in different hospitals. I have witnessed many incidents where women struggled to give birth.”
She believes that expectant mothers at some hospitals are not properly prepared for what to expect during the birth process. “What we do here is educate women about pregnancy and prepare them mentally, psychologically and physically for labour.”
As part of the Hala Baby programme, sessions are divided into 15 classes, beginning with an introduction to pregnancy that involves husbands and is followed by a birthing plan.
“Each patient is different, so each class is meticulously designed after assessing patients individually,” says Mrs Al Khatib, who has five children of her own. She is certain that with the right education many women would opt for a natural birth rather than a Caesarean section.
“The number of C-sections would drop once women get trustworthy information about pregnancy from A-Z,” she says. “Many women get scared of birth pain, so they go for the easy option. Women need to have a concrete birth plan, otherwise they will become part of another’s plan.”
Despite having a Caesarean delivery for her first baby, Umm Mubarak insisted on a natural birth for the twins she was carrying, despite being told surgery was advisable.
During her first labour, when she was 23, Umm Mubarak was told that the baby had a weak pulse. “In the end, doctors convinced me to have a C-section in the absence of my family,” she says. “They saw that I was too young, so they terrified me about the future consequence of not undergoing a C-section.”
For her second child, a daughter, Umm Mubarak was once again told the baby had a weak pulse, but disputed this. When the test was run for a second time the baby was fine, she says.
In the final stages of labour she was told her cervix was not dilated sufficiently for a natural delivery and was advised again to have a C-section. She refused once more, and just an hour later gave birth naturally. She believes the doctors were not honest with her about the danger.
With her twin boys, she says, all the doctors advised her not to take the risk and to opt for a Caesarean delivery.
Again she refused.
“Ahmed came out and his brother, Mohammed, followed him,” she laughs. “Allah made it easy on me.”
Today, seven of her children are fit and well. “Doctors often tell you that if you do one C-section, the next child will have the same. It’s a fallacy,” she says.
She blames the number of Caesarean deliveries on the generous healthcare offer with the Thiqa and Daman cards. “We don’t pay anything from our pocket. Hospitals take advantage of that and pressure people for C-sections. This way, they make more money and sacrifice less time for natural birth.”
aalhameli@thenational.ae
