We're not too posh to push, say mothers, but c-sections still rise

Doctors say the number of mums choosing to have caesarean sections is increasing at hospitals around the UAE.

ABU DHABI // Mothers yesterday defended their choice to have babies by caesarean section despite a preference by most doctors for natural birth.
"The 'too posh to push' impression is definitely still around," one mother told The National, "but why on earth would I choose to go through 24-plus hours of excruciating pain when I could just go through a 20-minute procedure?"
Of about 200 deliveries each week at Corniche Hospital in Abu Dhabi, the largest maternity hospital in the country, about 65 are by c-section. The figures follow a rising global trend, and put the UAE on a par with the United States and Australia.
Doctors can only advise patients on the pros and cons of a natural birth and a caesarean delivery, said Dr Muna Tahlak, head of obstetrics and gynaecology at Latifa Hospital in Dubai.
"It is your choice and nobody should force you, but an informed decision should be made only after you are given a full explanation and counselling.
"I think the consensus among the majority of obstetricians is to opt for a normal delivery unless there is a contraindication. This is the message we want to get across."
The World Health Organisation has recognised an increase in recent years of caesarean sections without medical need.
In a 2010 policy briefing it said the incidence rate of complications was three times higher with c-section deliveries than with natural births. Increased costs and higher risk of antibiotic resistance were other concerns associated with the growing trend.
Although opinion is divided, some health bodies have already taken a stand against the trend. The North Yorkshire and York Primary Care Trust in the UK banned elective caesareans last year to reduce health risks for mother and child, and to save money.
Between 3 and 5 per cent of c-sections at Latifa Hospital are by request. "Previously, women wanted to have a normal delivery, and sometimes insisted, even if a c-section was indicated. Now, it is like the opposite," Dr Tahlak said.
The reasons for choosing a caesarean might seem reasonable, said Dr Gowri Ramanathan, a foetal medicine specialist and consultant obstetric gynaecologist at Corniche Hospital.
"They could be worried about the pain, or that they might be alone during the birth, given how unpredictable labour is."
If, after a second consultation with another doctor, the patient is still reluctant to deliver naturally, then her choice will be approved.
The decision can be an expensive one, Dr Ramanathan said. "Maternal-request c-sections are not covered by insurance, so if a woman wants it, we can do it, but she will have to pay."
If there are no complications, a patient can expect to pay more than Dh12,000 for the procedure, which normally takes under an hour.
At Mafraq Hospital in Al Ain, caesareans are not favoured, said Dr Ramokone Mogotiane, chair of the obstetrics and gynaecology department, although consent will be given after a patient has been made fully aware of the risks.
The choice should be the mother's alone, said Charmaine Van Zyl, a psychologist at the Canadian Medical Centre in Abu Dhabi. "I find a lot of mums who say they can't even deal with the concept of giving birth naturally because of the pain."
As the number of c-sections a woman has increases, so does the risk of complications, which may lead to haemorrhaging or loss of the uterus.
There is no legal limit on caesareans but after three or four most health professionals recommend surgery to prevent further pregnancies.
A natural delivery was the only way for Nada Feda, 22, from Egypt, although that did not stop the thought of a c-section crossing her mind.
"There was no reason for me to have one, but the pain was so unbearable that I asked the doctors half-way through the delivery to stop and do the procedure. Unfortunately, it was too late."
The pain factor is a decisive issue for many women, said Mrs Van Zyl, who delivered all three of her children naturally and without any epidurals.
Coupled with a hectic lifestyle, and the option of knowing exactly when and how long your birth is going to be, elective c-sections are becoming increasingly attractive.
"It fits into, unfortunately, the fast-paced lifestyle that we have. The majority of women that I speak to in the practice all go for elective c-sections, and I have never met a woman who elected and then regretted her decision."
Doctors must listen to their patients, said Dr Tahlak. "I always believe the patient should have a choice, because I think it is the patient's right."
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