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Bangladesh doesn’t need more C-sections

  • Published at 04:55 pm July 17th, 2019

For safer births and a healthier country

As someone who has practiced medicine for several decades, I have seen medical practices change and new trends in health services emerge -- usually for the better. 

But I was quite appalled to see a new report from Save the Children, which found that 77% of all caesarean section (C-section) operations in Bangladesh are medically unnecessary, increasing 51% since 2018.

The problem is partly driven by policies that incentivize doctors to perform C-sections, regardless of whether the mother needs one or not. This is particularly rampant in Bangladesh’s unregulated private health facilities, where 80% of all births are now C-sections.

Doctors get paid more to perform a C-section than to attend a natural birth, which leads to unnecessary hospitalizations and surgeries for women. Ultimately, this puts their and their babies’ health at risk and drives up health care costs.

But the rise in C-sections is also partly caused by broader social and economic factors.

With rising incomes and a rapidly growing middle class, more and more women are demanding C-sections, because they think it will be quicker and less painful than natural birth.

Doctors who have a financial stake in their decision often reinforce these fears, providing misleading advice that subtly promotes a C-section.

This is a growing trend in Bangladesh and globally, where more affluent and educated women are more likely to have elective C-sections.

Additionally, Bangladesh faces a health professional crisis of both numbers and quality. Childbirth always comes with risks for the mother and baby. When all goes well, the mother is attended by a skilled nurse or midwife, only calling on a specialist when complications arise.

Sadly, there simply are not enough midwives to attend to deliveries, and nurses often lack the skills needed to determine the best course of action when things go awry. So they err on the side of caution, calling the doctor to perform a C-section, even when it’s not needed.

The belief that a C-section is safer, quicker, and easier than a natural birth -- touted by women and medical professionals alike -- is both untrue and dangerous. Even when C-sections are medically necessary to save a mother’s or a baby’s life, this procedure -- like any surgery -- comes with risks.

Unnecessary C-sections are associated with worse health outcomes for both mothers and babies. They increase the risk of blood clots, organ injury, infection, and neonatal respiratory distress, and cause other short-term complications.

There are also several long-term risks, including complications in subsequent pregnancies.

The situation is even more dire in low and middle-income countries like Bangladesh, where maternal deaths following C-sections, are 100 times higher than in high-income countries like the UK.

Over the past few decades, Bangladesh has made great strides in improving the health of mothers and babies, cutting the number of childbirth-related deaths in half since 1990.

But if the rate of unnecessary C-sections continues to increase at this pace, we risk undoing much of this progress.

As a country, we need greater investment in the training and education of midwives and skilled nurses.

This would increase the number of professionals who can deliver babies without a doctor and also improve the skills of these individuals so they are equipped to handle complications accordingly.

By doing this, we can help pregnant women and their families feel confident that they are getting the right recommendations about their delivery.

As physicians, we also have an obligation to educate women -- and their families -- about the risks and benefits of natural births and C-sections.

It is crucial that all women have access to the right information and services and can make informed decisions about how they choose to give birth.

At Praava Health, where I work, we focus on building relationships with pregnant women, providing pre-delivery check-ups, monitoring, and counselling them throughout their pregnancy, and providing care after they give birth.

These services are available at an affordable price through our annual membership plans. Getting to know patients and their families allows us to provide better guidance and clinical recommendations that our patients can trust.

Ultimately, the entire country needs a culture shift away from expensive hospital stays and medical procedures. Instead, we need preventative primary care led by family doctors.

We must move beyond simply diagnosing and treating women, and holistically consider their life circumstances, personal preferences, and values.

This type of medicine improves clinical outcomes and ensures patients feel satisfied, included, and confident in the care they receive.

Bangladesh has come so far over the past decade when it comes to protecting the health of mothers and babies. It’s time for us to build on this progress -- not reverse it.

By empowering women and their families to make informed choices about their health and improving the quality of care they receive, we can save C-sections for when they’re needed.

The result will be safer births and a healthier country -- a health trend I think we can all agree on. 

Dr Simeen Akhtar is the Senior Medical Director at Praava Health, which is raising the bar for health care in Bangladesh through international-standard doctors, diagnostics and technology.

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