PRIVATE doctors said last week they had been unfairly lambasted in the press for
favouring C-sections over natural births. Recent reports of doctors “blackmailing” women into booking their delivery at convenient times prompted outpourings of outrage from women, government health authorities and lawmakers.
“If there is one doctor who encourages his patients to have C-sections you can’t make a generalisation that all doctors do it,” said Dr George Leontiades, head of the Gynaecological Association.
Leontiades said recent accusations that the private sector was guilty of performing as many as one in two births by caesarean section were misleading. He said comparing Cyprus’ private C-section rate of 55 per cent to England’s 25 per cent was wrong.
“The numbers for the UK included the total, both government and private…. In England, in the private sector, the figures are almost as high as Cyprus,” he said.
Quoting a House of Commons report from 2002, the doctor said some private London hospitals had a C-section rate as high as 44 per cent.
“We have been accused of a high C-section rate when they are almost comparative to the private sector in all other EU countries. Even England and Scotland have differences, with fewer C-sections in England than in Scotland because there are not as many midwives in Scotland and more doctors,” he said.
Leontiades also pointed out that the percentage of private deliveries in England was 0.5 per cent.
“Do you know what the percentage of private deliveries in Cyprus is? It’s 70 per cent,” he said.
“There has been an increase in caesareans everywhere. They are higher in developed countries than in Third World countries,” he added.
Leontiades said there were very many reasons why Cypriot women chose to have caesareans, starting from how affluent the country had become.
“Affluence in societies affects C-section demand. Also women have a mistaken understanding of the hardship of labour. They don’t want to be put out. The way they have three cars, a big house and can buy everything in the supermarket, they think they shouldn’t suffer any hardship in bringing a child to life.”
The doctor said there was also an increasing trend in repeat C-sections. He said most women who had a C-section for their first child wanted to follow the “tried and tested” method and “don’t want to embark on an adventure that will not guarantee they will have spontaneous vaginal delivery”.
He said some doctors were also afraid of increased cerebral palsy risks during labour despite the fact that only one in 400 developed cerebral palsy, only 10 per cent of which accounted for events taken place during delivery. Nevertheless in a society where women only had one or two children, some doctors preferred not to chance it, he said.
“If you ask me a crucial factor is the absence of preparedness. Women need to be prepared and supported and given specialised advice and continued information that is going to eliminate the fear of labour,” he said.
For years the Association has appealed to the Health Ministry, House Health Committee and Medical Association for the operation of a midwifery school.
“We need more midwives because they are very useful in the whole process of preparation and the elimination of fear,” he said.
The problem was that the majority of midwives were absorbed by the public sector.
“About 99 per cent work for the government. Every time midwives retire they start a course for another 40 midwives and then the government employs them,” he said.
Following the establishment of Limassol’s technical university, TEPAK, and the introduction of its midwifery course, Leontiades hopes things will change.
“The question is when will they complete their studies and gain experience to help in this area,” he said.
Leontiades said the Gynaecological Association was in favour of natural births but that it was not unreasonable to have experienced increased caesarean rates in recent years. He also said comparing the private sector to the government was unfair and that no one had mentioned the six per cent rise in C-sections at the Makarios hospital in Nicosia.
“The majority of women using the government health services are Georgians, Romanians and Poles and women in a vulnerable situation with no financial support. They have no demands and are an entirely different inhomogeneous population. You can’t compare a Cypriot who goes privately with a foreigner. They have cultural and attitude differences. The foreign woman is more likely to think that because she is not paying and it’s a free service she should keep quiet and put up with whatever the doctors decide,” he said.
Nicosia’s Aretaeio hospital gynaecologist-obstetrician Dr Gabriel Kalakoutis said although women were not encouraged to have a C-section, there was greater sensitivity to a woman’s wants.
“A lot of women prefer to have a C-section because they are afraid of childbirth and the pain. I’m more prone to take the woman’s feelings into consideration and what makes her feel more psychologically comfortable. C-sections are much safer now, with very small risks and only slightly more dangerous than natural births.”
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Kalakoutis said the attitude that a C-section was a “failed” delivery no longer held true and that if there were medical indications for why one should be performed he no longer insisted on going the natural route.
“Now the trend in most countries is an increase in caesareans. It could also be a cultural trend after many celebrities were reported as ‘too posh to push’,” he said.
“Some women want to have a natural birth and I encourage that. If some are afraid and from the beginning think they want to have a C-section then I am more open to that. I don’t tell them from the beginning that they should have a C-section,” he said.
The gynaecologist said in his experience four out of 10 pregnant women asked for C-sections. He also said culturally women had changed and were having fewer children.
“Women have two or three children, not five or six. If they had that many caesareans it would be dangerous but up to two or three is safe,” he said.
Kalakoutis said other reasons for an increase in global C-section rates included more breach babies being delivered this way, the increase in IVF treatments resulting in more multiple births making C-sections likely, lifestyle choices and a genuine fear of labour.
