Free natural baby delivery? No way, say Iranian women

Iran is trying to curb the number of babies delivered through Cesarean section but women are unlikely to be swayed.
An Iranian mother and her daughter at a hospital in Tehran on December 30, 2013. Maryam Rahmanian for The National
An Iranian mother and her daughter at a hospital in Tehran on December 30, 2013. Maryam Rahmanian for The National

TEHRAN // Inside a baby clinic in a large private hospital in western Tehran, about 30 new mothers sit waiting for paediatricians to check on the health of their children.

Amid the babies’ cries, the women chat about the changes in their infants’ behaviour or any sicknesses they may have picked up. All the mothers have played their part in Iran’s continuing drive to boost its population. But in doing so they have contributed to another trend that is alarming the authorities.

All gave birth by Caesarean section.

Iran has the second highest rate of Caesarean births in the world, with only Brazil having more. Iranian health officials want to reduce the number of babies born using the surgery from the current 54 per cent to 35 per cent. That figure is still some way off the World Health Organisation recommendation of 10 to15 per cent.

Many in major Iranian cities consider natural childbirth to be outdated. Caesarean delivery is viewed as a sign of modernity and freedom of choice for Iranian women, and not simply a last resort to avoid complications.

“Of course I would go with Caesarean,” said Shirin, 34, who was waiting to see the paediatrician with her 18-month baby girl Mana. “It was really easy both before and after delivery, although some say it is a real surgery and it may be dangerous.”

“But, a team of doctors was around my kid and me. We knew the date and were ready for it. To be honest, I think natural delivery is more risky here.”

But her choice is now conflicting with the efforts of Iran’s health authorities.

Earlier this month, it was announced that natural childbirths would be free of charge to all Iranian women. The policy is part of a drive that started in recent years to increase the population after years of low growth.

But in making the announcement, Mohammad Haji Aghajani, the deputy health minister, said the change also aimed to reduce the craze for Caesarean deliveries.

In Tehran, Caesareans are as common as nose jobs, also a dominant medical trend among Iranians, who have become prone to elective surgeries.

Some luxury hospitals in Tehran only offer to perform Caesarean deliveries.

Caesareans cost between Dh1,800 and Dh4,800 depending on the hospital and the part of the country, with Tehran being the most expensive.

While some young mothers believe Caesarean sections are easier because they can pick the delivery date and can be more mentally prepared, others complain that they simply choose the surgery due to Iran’s lack of adequate services and information about natural childbirth.

The demand for the surgery is so widespread that in some cases it is a challenge for women to find a doctor who will deliver babies naturally.

“I’m sure I could give birth to my son naturally, but my gynaecologist said she wouldn’t do that,” said Yasaman, 30, a manager at a private company who finally gave birth to her first child four months ago through Caesarean. “Almost all of the doctors I visited were reluctant to deliver my baby through natural birth.

“My doctor kind of pushed me into having a C-section.”

Iranian gynaecologists say part of the reason the doctor’s are so keen to promote Caesareans is a financial one — they get more money for performing the surgery than they do for a natural birth.

“Doctors do not receive enough compensation for what they do in a time-consuming natural birth,” said Dr Fereshteh Haghighat, who practices in both Tehran and Isfahan. “So, they are not willing to commit their time to it. Also, Iranian doctors performed so many Caesareans, and they are very expert in the procedure. Therefore, it is less risky for them,”

With each procedure taking about 45 minutes, some doctors are tempted to perform several a day and earn much more than those who just carry out natural births.

“I do six or seven Caesareans in a week, but some doctors do 20 of them,” said Maryam Maleki, a gynaecologist in Tehran. “As long as doctors are in charge of delivery and not midwives, the rate of Caesarean will go up, because doctors won’t risk keeping a mother waiting in pain for hours on end.”

The push to encourage more women to return to natural births has been welcomed by some women.

Niloufar, 45, a housewife, gave birth to both her children, now 17 and 10-years-old, naturally.

“It is called natural birth, why should we undergo surgery and make it artificial?” she said. “It was not easy, but it was not as complicated as Caesarean. There was no after delivery side effects such as infection, bleeding or depression,” she said.

Before last week’s announcement that natural births would be available free to everyone, regardless of health insurance, natural births cost between Dh200 and Dh370 in state hospitals and around Dh450 in the private hospitals.

While it is expected that the new policy will benefit poorer Iranian families, some remain sceptical it will discourage the popularity of Caesareans

“It is a very helpful decision to low-income strata. Although they were always using natural birth, as it was considerably cheaper,” said Dr Maleki. “The decision will definitely motivate them to have a third or in some cases fourth child, but it wouldn’t change the rate of Caesarean in middle class families and private hospitals.”

Published: May 21, 2014 04:00 AM


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