Health workers prefer CS births for first-time mums

Healthcare providers favour caesarean births for first-time mothers, over natural births, even when there is no emergency, a new study has shown.

The study published in PLOS One measured the association between individual provider attitudes towards childbirth and the likelihood of caesarean sections, and found that some healthcare providers suggest caesarean births routinely, even before consulting the mothers.

As a result, caesarean births have risen above the level of necessity and become a contributor to maternal morbidity and mortality.

For the study, 400 providers were surveyed on their attitudes towards various aspects of labour and birth. Their first-time caesarean birth rates for 2013 and 2014 were also obtained. The researchers also looked at the gender, years of experience, practice location and the primary hospital’s caesarean section rate.

In total, more than 200 participants (obstetricians, family physicians and midwives) completed the survey and 109 of them performed caesarean births. The researchers found that the attitudes of the birth provider determined whether they offered a caesarean birth over a vaginal birth.

Based on the findings, the researchers recommend further scrutiny of how health workers are acculturated during training and while in practice, and how professional interactions may modify these attitudes to ultimately improve quality of care and health outcomes.

OPERATION

Kenya is grappling with rising caesarean births, for which the National Hospital Insurance Fund (NHIF) paid out Sh1.2 billion. caesarean sections accounted for 58 per cent of NHIF’s maternity costs as one out of three women on the cover underwent the surgical operation. This has raised concerns that hospitals could be pushing women to surgery for financial gain.

In 2015, NHIF increased the amount allocated to CS births per woman from Sh18,000 to Sh30,000, while normal delivery is allocated Sh10,000. This made the procedure relatively affordable for women who had to top up to cover the costs in the past. Like private insurers, NHIF does not cover elective caesarean sections. However, NHIF says that this has not kept CS births, which have surpassed the Fund’s budget, in check, and this has forced the Fund to begin stringent vetting to determine if the all the caesarean births offered to mothers are really emergencies.

The World Health Organisation has also observed that caesarean section has become one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries.

“Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at risk of short- and long-term health problems,” notes the international health agency.

Although C-sections are generally considered safe and, in some situations, lifesaving, doctors say they carry additional risks compared with a natural birth.