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The C-section rate among Discovery members is now up to three times higher than at American celebrity hospitals - here's why

Helena Wasserman , Business Insider SA
 Apr 20, 2019, 06:52 AM
c section
  • Some 74% of babies delivered to Discovery medical scheme members are now born via C-sections.
  • This is out of whack with C-section rates across the world - even much higher than in celebrity US maternity wards.  
  • SA doctors fear legal claims, which are blamed for the high C-section rate. 
  • For more articles, go to Business Insider SA.

Only one in four babies born to Discovery medical scheme members is delivered naturally, a new report from the medical scheme shows.

natural c sections
(Discovery)

Discovery’s rate of Caesarean births has now reached 74% - which is almost three times the South Africa public hospital average of 26%. It is also completely out of whack with some of the richest countries in the world: the Netherlands has a C-section rate of only 16%, with Sweden at 18%, France at 21%, Spain at 25%, the UK at 26%, and Germany at 30%.

Increasingly, C-sections seem to be a go-to option among medical-scheme members even in low-risk, non-emergency deliveries - leading to the inevitable (and misplaced) criticism that mothers are becoming “too posh to push”. Still, even among the poshest celebrity hospitals in the world, the Discovery rate of 74% is extremely high.

Take for example Cedars-Sinai hospital in Los Angeles, which is where Kim and Kourtney Kardashian and Victoria Beckham gave birth. Its C-Section rate was 24.3% in 2018. Mount Sinai hospital in New York, which Gwyneth Paltrow chose, has a C-section rate of only 21.5% in 2016.

See also: Most South African babies born this year won't see the 22nd century – here's why

Beyoncé reportedly paid more than $1 million to rent the entire maternity floor of New York’s Lenox Hill Hospital, which has a high C-section rate (39%), according to the latest records we could find – but still nowhere near the Discovery rate.

Across the developed world, governments are trying to reduce C-section rates, with the US aiming to limit C-sections in low-risk pregnancies to below 24% by next year.

This is the biggest reason for the sky-high C-section rate in SA

The single biggest driver of the high rate of C-sections in South African private health is the fear of being sued, says Stellenbosch gynaecologist dr Johannes van Waart, a former president of the SA Society of Obstetricians and Gynaecologists (SASOG).

This view is supported by Dr Jonathan Broomberg, CEO of Discovery Health, who also singled out the high rate of malpractice litigation as a main reason for the C-section rate among Discovery members.

See also: Prince Harry will reportedly take two weeks of paternity leave — and stacks of research suggest paid leave is a no-brainer

Van Waart estimates that 98% of all legal claims related to obstetrics involve vaginal births.

Given the threat of legal claims and the financial risk, obstetricians are simply unwilling to do a natural delivery with a reasonable chance of complication, he says.

But professor Lut Geerts of the Department of Obstetrics and Gynaecology at Stellenbosch University says both doctors and mothers may underestimate the potential risks of C-sections to both mother and baby – which is contributing to the sky-high rate.

“It also seems like some women are not aware of the advantages of a vaginal birth for their infant.”

She says C-section risks include:

  • anaesthetic complications
  • postpartum haemorrhage (including a higher risk for hysterectomy)
  • infections
  • venous thrombosis
  • trauma to abdominal structures
  • “subfertility” following the birth
  • And in subsequent pregnancies: “abnormally invasive placenta, scar pregnancy, uterine rupture, difficult repeat surgery, later complications of adhesions (e.g. bowel obstruction) etc.”

Risks for the baby include accidental cuts, respiratory complications (especially if it is an elective C-section before the due date) and lower success rate for breastfeeding (with all its long-term effects), says Geerts.

Geerts says the colonisation of baby’s skin with different spectrum of bacteria (which is possibly linked to asthma) is another drawback of C-sections. New research, published by the European Congress of Clinical Microbiology and Infectious Diseases this month, shows that babies delivered naturally had a very different make-up of gut bacteria, and that those born by C-section are slower to acquire certain types of “good bacteria”.

Why some doctors prefer C-sections

While Van Waart estimates that obstetricians earn on average 10% less for a C-section than for a vaginal birth, Geerts says some doctors may prefer C-sections because of the convenience of pre-planned elective surgery. Scheduling a C-section means doctors can avoid after-hours work as well as unplanned interruptions in daily appointment schedules.  

Another consideration is the lack of reliable support from the hospital in terms of skilled midwifery assistance or theatre access in case of an emergency, she adds.

Why some moms prefer C-sections

Geerts says the high C-section rate is also in part due to some South African women wanting an exact delivery date convenient to them or their families, as well as their fear of labour pain and vaginal damage. “Some patients do not value a natural birth anymore and want to be in control.”

No doubt, however, that C-sections are saving lives in high-risk deliveries.

"(But) while it is great that the safety of C-sections has improved very much over the last few decades, this does not mean that C-sections can be seen as 'minor' interventions and it is clear that far more C-sections are being done than what brings any health benefit to the population."

The article has been updated to reflect the most recent C-Section rate (24.3% in 2018) at the Cedars-Sinai hospital in Los Angeles.

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