Caesarean sections should only be performed on expecting mothers when it is medically necessary, the World Health Organisation (WHO) has warned in a new statement on the issue.
As they increase in prevalence, C-sections are becoming one of the most common surgeries in the world, particularly in high- and middle-income countries such as Qatar.
The procedure, in which one or more incisions are made through a mother’s abdomen and uterus to deliver one or more babies, can save lives. But it is increasingly performed without medical need and in some situations can lead to complications that result in disability or even death, WHO said.
Since 1985, the recommended rate of C-sections has been believed to be between 10 percent and 15 percent of the total number of deliveries performed nationally, but nowadays many countries exceed this.
By the numbers
According to a Qatar Health Report published in March last year by the Supreme Council for Health, Qatar’s total rate of C-sections stood at 23.8 percent as of 2011.
That’s more than 8 percent above the recommended figure, although still a little behind the OECD average of 25.9 percent.
The rate was determined based on a total of 20,001 deliveries, with 87 percent (17,632 births) of them taking place in Hamad Women’s Hospital, while the remaining 13 percent (2,630 deliveries) occurred in private hospitals.
However, the figures differed significantly between public and private hospitals. Public hospitals had a C-section rate of 21.8 percent of deliveries, while private hospitals had a rate of 37.5 percent.
Compared to a 1998 report, when Qatar’s overall rate of C-sections hovered around 16.3 percent, the report concluded there was a “significant increase” in the number of such surgeries being performed here, in line with a similar trend in other OECD countries.
Among the reasons cited by the report for the overall increased rate were reductions in the risk of Caesarean delivery, patient preference and increases in maternal age at first birth, which contributed to a rise in multiple births from assisted reproduction.
In Qatar, an additional reason that may be pushing up the numbers is that many women who have had one C-section elect to deliver using the same procedure for subsequent children.
In its latest statement, which was issued this week, WHO said that when medically necessary, a C-section “can effectively prevent maternal and perinatal mortality and morbidity.”
It pointed to new evidence that shows when Caesarean section rates rise toward 10 percent across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10 percent, there is no evidence that mortality rates improve.
“There is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure,” the statement said, adding:
“As with any surgery, caesarean sections are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care,” the statement warns.
The director of WHO’s department of Reproductive Health and Research, Dr. Marleen Temmerman, added: “These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns.
They also illustrate how important it is to ensure a caesarean section is provided to the women in need – and to not just focus on achieving any specific rate.”
One of the issues surrounding high rates of C-sections is that, due to their increased cost, they can pull resources away from other services, particularly in countries with overloaded and weak health systems, the WHO statement concluded.
Cost of delivery
An earlier WHO study on C-section use internationally, which was published in 2008, looked at the number of such surgeries performed in 137 countries and found that 6.2 million unnecessary sections were performed, at a cost of US$2.32 billion.
That report concluded:
“CS that are possibly medically unnecessary appear to command a disproportionate share of global economic resources. CS arguably function as a barrier to universal coverage with necessary health services. ‘Excess’ CS can therefore have important negative implications for health equity both within and across countries.”
Rates of C-section procedures vary dramatically globally. China has one of the world’s highest rates of the delivery, as around half of the nation’s 16 million babies in 2010 were born in this way, according to a study in the BJOG, an International Journal of Obstetrics and Gynaecology. In the US, the rate is 33 percent, according to 2013 WHO data.
Within Europe, figures for the surgery vary. Around a quarter of all births in the UK are by C-section, while in Sweden, some 17 percent of deliveries are performed these way. Meanwhile, in Cyprus, the figure is 57 percent, according to the BBC. These include planned C-sections as well as emergency procedures.
While Qatar’s rate is certainly not the highest in the world, its rapidly expanding population means that more births by C-section could lead to rising healthcare costs.
The number of deliveries in the country’s public hospitals alone last year rose by 4.5 percent by 2013, and last month Hamad Medical Corp. (HMC) said it was encouraging residents – especially expectant mothers – to consider treatment outside of Doha in a bid to spread the pressure on key healthcare facilities.
Have you delivered a baby in Qatar? Thoughts?
1. If a women opts for C-section, that’s now ones business but the women.
2. I personally believe C section is safer for a child. There are several risk associated with natural child birth espically if an infant “get stuck” in the womb.
3. The real reason behind c-section are because private hospitals actually encourage it! C-section costs about 50% more than natural child birth. Also the mother is required to stay in hospital twice as long, more profits for hospitals. Doctors encourage because private hospitals pay doctors a commission on surgeries. It’s in their economical interest to encourage a doubtful mom on a c-section.
In a very popular private hospital in Doha the best OBG consultant won’t see an expectant mom unless it says in her file c-section and will transfer her to a different doc if she opts out of elective c-section
“stuck in the womb”? Would you care to back that ridiculous statement up with your medical certificates? What’s that? You’re not a doctor? Thanks, but I think that all of us in the world with more than three functioning brain cells will take the WORLD HEALTH ORGANISATION’s word for it.
Thanks for sharing though.
I have four brain cells thank you very much … And no I can’t back it with proper medical terms because had i gone to medical school I won’t be wasting time here arguing with you..
I’ll give you an example and if a OBG dr passes by he or she can help give us more specific medical terms..
My nephew suffers from severe mental disabilities as a result of simply him being to big of a baby that got stuck in his mother birth canal resulting in shortage of oxygen for a period of time.. By the time the dr used a scapulae and a suction whatever to get the baby out he had already lost enough oxygen to cause brain damage … Had the mother opted for a c section this would have not happened and she would have had a healthy big boy by now..
El hamdou’Allah they both survived this though your nephew is being disabled due to this. I personally do believe that here also the qualifications and the experiences of Dr. are important. Plus they should have been able to estimate the birth weight, and see whether the mum would physically be able to birth her baby. Plus during labour the Dr. should have reacted way faster if baby got stuck in the birth canal (this does happen from time to time, usually then a forcep is being used or a c sec is being performed). Hope though your nephew can somehow live a good life (I know personally what it means…)
While your anecdote is unfortunate and I’m sorry for your nephew’s suffering, it is just that – an anecdote. You can’t generalize based on one (or 10) stories.
But I’m entitled to my opinion based on experience c-section is a safer option for the child
No, you just can’t have an opinion on something that requires expert knowledge. That’s like me saying “It’s safer to not wear your seatbelt. My friend once got into an accident and he was thrown out of his seat, saving him from being crushed”. (true story by the way. Always wear your seatbelt though!)
You are however entitled to be dumb if you so choose.
The way my grandmother eat sugary stuff through her life time till she died a 95 years old, if i follow her foot step, i will not get to 50 years before i expire. i will not tell the whole world old age to eat sugary stuff just because my grandmother live till 95 doing it. Humans are different, our body system is different but what is not different is an accepted general standard and what is normal around the world.
Deleting for personal attack (again)
Neither of my posts was anywhere near being a “personal attack”. This is an outrageous power trip.
You used dumb and something like just having 3 brain cells … while commenting on someone’s post … wouldn’t really say these are compliments either …
“not a compliment” is a far cry from personal attack.
It’s my fault for giving page views to this rag. What was once a shining light in the hellscape that is Qatari journalism has become a center for narcissistic power tripping and pretend reporting.
I didn’t say it was an attack, just not nice as well 😉 was just trying to explain why this had been said, not sure if I was right with my way of thinking …
You cannot generalize that c secs are a safer option for babies and mums, cuz it is not the case. With your nephew it would have been better, totally agree, but here comes what @Ali is saying – the Drs here need the skills to make the right decisions. I have been very very fortunate (el hamdou’Allah ya Rab) that I had very good Drs and midwives when I delivered my 2 babies here, though one birth developed to be risky in the end. Still, my Dr at that time did the right things, as she knew how to handle difficult situations. But not only Drs need to be skilled but also nurses and midwives, and here I sometimes had my doubts …
The term is obstructed labour might be the result of various maternal and foetal factors .C section is the last choice but before going for c section there are options like forcep or episiotomy assistance for delivery . the doctor decision and skills to evaluate the event correctly and choose the best procedure is the key element. Well regarding WHO warning there are again various factors involves like insurances and business of hospital , percentage of doctor as per procedure and most importantly Skills unfortunatly the first two mentioned above highly responsible in pvt clinics and hospital and the last one totaly lack in HMC. Usually in HMC majority of procedures are adopted as per UK or USA standards but unfortunatly they forget that their patients are not UK or USA habitats.
Deleting for personal attack.
A c sec is definitely not safer than a normal delivery. It actually can actually cause more risks overall, plus if you’re planning to have more kids it might be difficult to have a normal delivery after a c sec.
I do agree that c secs safe lives (it definitely saved mine and my mom’s), but I do believe many women nowadays choose a c sec because they are afraid of actually going through the whole labour pain. Our bodies have been built to bear a child, Mother Nature was clever in that…
Thus why I prefer not to give birth in this country…money is the main objective in private hospitals here, plus hearing stories of the pre and post delivery experiences of some women I knew — it’s scary.
The key statement is “Public hospitals had a C-section rate of 21.8 percent of deliveries, while private hospitals had a rate of 37.5 percent”
What would be interesting is data on Health Insurance coverage as well – won’t be surprised with a higher percentile for C-section with full insurance coverage
Usually the health insurance covers up to a certain amount for the entire pregnancy, that is including delivery. Sometimes couples end up paying quite a high amount in the end…
Yes true it is policy dependent but nevertheless premier plans with good maternity terms provide up to QAR 40K – QAR 45K annually for pre-natal/post natal care/normal delivery/Caeserian section. Anything over and above the annual limit would be payable by the member (parent).
A normal delivery earns less revenue than a caeserian section – which is why insurance co’s now charge a 20% co-insurance (for one service provider atleast)
My insurance only covered upto 20k, that was 3 years ago, for a full pregnancy with delivery (not annually), and we had to pay our fair share in the end. A c sec at one of the more popular hospitals in Doha is now around 30k (normal delivery I think roughly half of this), doesn’t leave much for the prenatal care (considering their fees for monthly visits, blood tests, the ultrasounds they are doing every time you visit there…). This made me decide to go to HMC last year, and I have not regretted anything…
Hamad hospital has less c section but I would also like to see their rate of infants dying at Hamad hospital. Because I know several women who have lost their babies at Hamad due to long labor hours or other complications that could have been solved by a c section.
I haven’t heard about anyone losing their baby in a private hospital here.
Also I know a lot of Qatari opt for c section because they don’t want to go through labor.
Last year, my sister lost her baby on the day she was supposed to deliver at Al Ahli. They never even gave a proper report on what happened. If anything, Hamad Hospital harbors the doctors who know what they’re doing.
My wife gave birth to our first child, a big baby boy last year in woman hospital through normal delivery glory to God. it was smooth and a beautiful experience. Moment we discover she was pregnant, i told her to try to be healthy, keep fit drink lot of water, eat good food and light exercise of course with my supervision and help all through. i detest any surgery. i don’t like to hear the word “c-section”. thankfully and luckily for us God is on our side and everything went on smoothly of course with delivery pain according to my wife.
BIG THANK YOU TO HAMAD WOMENS HOSPITAL
I do not blame mothers who decided to go for c-section as all woman are not the same in terms of health, psychological, emotional and mental strength to go all the way but my believe and thinking is that once surgical procedure in which one or more incisions are made through a mother’s abdomen and uterus, the skin and body will never be the same again.
For me, to reduce the high rate of c-section, i believe pregnant woman + their husband need to be educated. Many do lot of things during the pregnancy without knowing consequences of their action e.g pregnant woman drinking tea, pepsi through out the day instead of drinking water, eating sugary stuff morning afternoon and night, not exercising (light ones,like house work, cooking, working in the mall, always try to seat right etc) thinking exercising result in miscarriage, sleeping through out the day, thinking pregnant woman should do nothing but to sleep 24hrs. swallowing medicine because of slight headache or body pain instead of a light walk out on the corniche for fresh air. and many more.
El hamdou’Allah your wife delivered safely a health boy, alf mabrouk 🙂
Yes I do agree that pregnant women and also their husbands need more education, but then again nowadays you can find so many things on the WWW, and let’s be honest this is where we are on rather frequently on a daily basis. Still, I believe pre-natal classes should be made more easily available, maybe at a small fee (we did one class 3 years ago, paid nearly 2k at that time which was fine for us but might not be good for others). When it comes to post-natal care I believe a lot has to be changed in here, it’s nothing like how a post-natal care would be in my home country.
During both my pregnancies I had tea, pepsi, slept a lot, and had heaps of chocolates as I was craving for this 🙂 And still everything was normal, though I do agree that a healthy lifestyle can help you a lot. And yes, being pregnant does not mean you can’t even do some light exercise or house chores etc
You are right and that is why i said pregnant mothers are different, people are different. my grandmother of blessed memory drank pepsi a lot even at 85, 90 years of age till her death at 95 she was very healthy. But generally eating too much of sugary stuff is not good for a pregnant mother. maybe if she abstain from it she will still be alive today. maybe if she does not eat lot of sugary stuff she would have died earlier than 95 who knows. But generally water should be encourage and sugary stuff should be discourage.
Yes light exercise like housework and cooking is good for all woman…..I’ll let my wife know she needs to cook and do housework to keep in shape… that’s after she has worked a ten hour plus day as a senior executive…yes that’s right she is woman and is a senior executive…wow! …..good grief, Qatar…welcome to the 18th century sexism. .
I think what he was meaning to say is that pregnant women shouldn’t use their pregnancy to not do anything anymore ;). Quite a lot do house chores and coooking, nevertheless if they work 5 hours, or 12 hours a day – but once they become pregnant they push this aside … running after my toddler and doing some cleaning did keep me fit 😀
…brilliant. Thank you
I am not surprise you did not understand my points. I read lot of your comments day in day out. I am not talking about senior executives pregnant woman who already does lot of walking doing office stuff for 8 hrs. I am talking about lazy full house wife who does nothing but to sleep through out the day. but then again, a senior executive can still pick one or two point from my comment in terms of drinking lot of water and less sugary stuff. My personal opinion.
You miss my point which is your comments are not up to date with modern times, womans rights etc etc. By the way she just cooked me a steak, thanks.
modern times….what right are you talking about? kindly expatiate.
Added to my point, what is wrong if you stay with your senior executive wife in the kitchen cooking dinner together charting later in the day? could be fun you know.
Expat Woman Disease. – Too Posh to Push.
Sorry but this is not only an “expat woman disease” … there are quite a lot of local ladies as well who are opting for a c sec …
My Wife just delivered a big healthy boy 2 weeks back at Wakrah Hamad. It was our first child and the experience was Horrific.
My wifes water bag broke on Friday morning 05:30 AM . We were all excited and went happily to Wakrah Hamad. They did an initial check and said she is not dilated. So kept her under observation for 1 full day. Next day morning nothing happened so they decided to induce her. So took her in the labor room on Saturday morning and started inducing. Still no dilation. So then they gave her Synto for her contractions. every 8 hours they kept inducing her with pain. She was crying for a C-section but they refused saying baby was ok and they prefer a Natural birth. This kept on going until Sunday. She was now 2 days without water. But praise the lord baby was fine as they were monitoring his Heart beats. Suddenly Sunday evening they decided for an Emergency C- Section. So they took her and my baby was born Sunday evening. and praise the lord both of them are fine.
But still wanted some clarity on the points below:
> We were open for C-section so y didnt the doctor agree?
> After the delivery of a 4kg baby, the doc says to my wife you never would have delivered the baby naturally as the baby was big. Y didnt you do an ultrasound to find this ?
> After birth the baby was suffering high level Jaundice and was kept in NICU for 2 days. why couldnt the doctor prevent this?
> The doctor who told us that my baby was taken to NICU was himself scared and petrified. is that the way you inform new parents about thier babys conditions?
> Y would you make my wife go through so much pain coz you were just negligent?
So many unanswered questions.
One suggestion, please go private or try the Cuban Hospital which i heard is nice. Wakrah Hamad is certainly not a recommended option.
Congratulations on the healthy arrival of your baby! The Drs at Hamad(regardless of location) are very supportive of natural birth and unless there was a problem with the baby, or your wife was too physically exhausted to continue they will keep trying to achieve that natural birth where possible. 48-72 hour labours are not that uncommon, and a 4kg baby is not necessarily too big, I had my eldest naturally and she was 3.7kg. Ultrasounds are not the most reliable at determining weight, especially towards the end of pregnancy.
Jaundice in newborns is also very common and is reasonably normal, the Dr would not have been able to detect this prior to birth without an invasive test so treating it after birth is to be expected.
I can’t comment on the attitude of the Dr, but to be honest it sounds like you had a pretty normal birth experience, just one where the Dictors didn’t communicate well to you, which again is pretty common here. Birth can be a scary experience when you don’t know why is going on, but try to focus on the fact your wife and baby are here and healthy and enjoy your new life as a family
Thank you 🙂
First of all congrats on your baby boy, and good to know that both are healthy.
As Guest78 mentioned, labours lasting more than 24-48hrs are not so uncommon, and pain unfortunately is there most of the time. In Europe they would wait even longer after the water breaks before inducing, giving that mum and baby are ok (you usually don’t loose all water at once).
I also agree that they should have communicated better with you, however they try not to rush to a c sec if medically really not necessary. This is for Hamad, I know in a private hospital they would have performed a c sec much earlier.
You can deliver a baby of 4kgs, unless your frame really is small and fragile. Mother Nature made us this way, subhan’Allah 🙂 An ultrasound can give you an estimate of baby’s weight, however it is not always correct. My estimations with my babies were more or less correct, however I know that a difference of 400 – 500 grams are not uncommon.
Jaundice is something rather common in babies, both of mine had it. Some need more treatment in the hospital, others can be treated at home. You can’t really prevent this though …
Pain, again, is part of the labour process, though I do agree they should have given her something to ease this. But then again once you have an epidural, you can’t move, and it makes birth even slower (at least it has a tendency for this).
I am sorry you had such an experience in Wakra Hospital, I delivered there myself and couldn’t have been happier there. I also delivered in a private hospital before, but personally would prefer Wakra over it if I ever had a baby here again.
Hope your wife and baby boy are recovering fast, and please tell her to ask for help if required, in any way. Good luck!!!
thank you 🙂
Glory to Almighty your wife and baby are doing great.
My big baby boy weight is 3.8 when my wife gave birth in Hamad Woman Hospital march last year. my wife weight was 64kg. Thankfully, baby and mama are very healthy Glory to God. So, illusionist wife is right. its absolutely possible to deliver 4kg baby safely but of course it depend on many factors according to my previous comment here.
I completely agree communication is a big problem in Qatar.
BIG THANK YOU TO HAMAD WOMENS HOSPITAL… They are really care… my baby also comeing c section but not rush because they always want normal delivery but if you are broke water what can u do of course safe life both c section . wife and baby fine baby going grow well momy going small…:)))
Reading this.. I am so confused!!! My wife is pregnant and its only 5 weeks. Can anyone suggest any good gynec or hospital. I am getting mixed responses from different websites. We just went to a private hospital for the initial checkups. and got the date for first scan.