Fear of litigation, HIV risks push up C-section numbers

Are South African mothers being pushed towards caesarean-section births by doctors wary of botched natural births?

While experts agreed that the risk of litigation was making doctors less inclined to encourage natural birth, one obstetrician said money was not the only reason women were opting to go under the knife.

According to The Lancet medical journal last week, the number of women having caesarean births has almost doubled between 2000 and 2015 – from 12% to 21%.

In South Africa, C-sections were higher than the world average in 2016, according to the Sexual and Reproductive Justice Coalition.

The coalition chairperson, Marion Stevens, said that far too often, natural birth is forgone by mothers because an increasing number of private obstetricians avoided “natural birth” patients altogether.

Stevens said the decreasing rates of maternity-related deaths was not an indicator that C-section births were necessarily healthier.

“We have always had a very high rate of C-sections,” she said. “The doctors don’t necessarily encourage you to opt for the C-section. They will simply say, ‘I don’t do normal deliveries, I only do C-sections’.

“This is often suggested because of the insurance implications, and the possible litigation connected with natural births. Obstetricians are very nervous to do deliveries because normal deliveries have a very high litigation rate.”

But Dr Peter de Jong said healthcare for women was far more patient-centred than it was before.

De Jong, an obstetrician, was not inclined to believe that there were more C-sections than necessary, contending that HIV was the deciding factor in South Africa.

“As an ‘inner city practice’ obstetrician contracted to most popular medical aids, I have a large number of HIV-positive pregnant women, and our [infections and diseases] colleagues advise elective caesarean deliveries to prevent mother-to-child-transmission.”

Other factors pushing women towards C-sections, De Jong said, included policy gaps and poor anaesthetic cover, which made it more cumbersome for doctors to perform natural births.

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