A LACK of midwives has been cited as one of the main reasons for the constant rise in caesareans, with latest figures showing that well over half of Cypriot women either opt out of giving birth naturally or are encouraged to do so.
According to Niki Panagiotou, the president of the Cyprus Association of Midwives and Nurses’ midwifery committee, a whopping 44.1 per cent of women giving birth underwent c-sections in state hospitals up until the end of October this year, an increase of around 12 per cent since 2007. The figures are even higher in the private sector, standing at 57.4 per cent in 2007.
“In 2009, 34.77 per cent of births [in state hospitals] were by caesarean and in 2010 – until the end of October – this had risen to 44.1 per cent. In 2008 the numbers were fewer and the year before even more so. You can immediately see the difference,” said Panagiotou.
If independently verified, these figures would now put Cyprus ahead of Brazil which, according to the World Health Organisation’s (WHO) Statistics Report for 2010, has the highest state hospital caesarean figures in the world at 41.3 per cent.
Although Cyprus was among the 193 countries surveyed in the WHO report released earlier this year, it provided no figures for its caesarean rates, and the most recent official statistics are contained in the Perinatal Health Survey 2007 which was issued last week by the Statistical Service.
This showed that 50.9 per cent of women overall had undergone caesareans in 2007, while a mere 11.8 per cent delivered without any obstetric intervention.
The survey showed that 57.4 per cent of the c-sections in 2007 had been carried out at private clinics and 31.9 per cent in the public sector. The figures showed that for 37.6 per cent of women the caesarean had been planned even before the onset of labour.
The figures put Cyprus way ahead of the UK with its 22 per cent caesarean rate and the United States at 30.2 per cent. Until this year the WHO recommended that no more than 10 to 15 per cent of a state’s births should be by caesarean and only when it is clinically needed.
Panagiotou, who works at the Makarios Hospital in Nicosia, says one of the main reasons for these increases is that women ask for c-sections, either because they feel they will avoid the pain of childbirth or because they would rather plan the whole procedure. In other cases, Panagiotou added, women are convinced by their doctors to undergo planned caesareans.
“But this is where the midwife comes in: if we had the time to sit and prepare women for childbirth and provide them with much-needed psychological support and advice, I am convinced these numbers would decrease,” said Panagiotou. “But we are 170 island-wide and we can’t even keep up with the basics. We want to do more, and we are working to the best of our abilities. There are simply not enough midwives.”
She said preparing a woman psychologically for birth was a large part of the whole procedure and the responsibility lay with the midwives.
And she did concede that there were weekly prenatal lessons in public hospitals, despite the problems.
“But it s one thing to lecture, and another to hear the woman’s thoughts and concerns,” Panagiotou pointed out, adding that the association had for a while been pressing for the creation of special groups, where couples could meet up and support each other emotionally.
“This will empower the woman and this is why we want to do it,” said Panagiotou.
However, their requests keep falling on deaf ears, as using the financial crisis as a pretext, the Health Ministry has said it simply can’t employ the five or six added midwives the groups would require.
Another worrying dimension is that c-sections are leading to a reduction in women who breastfeed.
“We want to convince women that they should breastfeed, but with caesareans, the possibilities of breastfeeding reduce, as the mother is in pain, on a drip and in recovery,” she said, adding that the midwives inevitably often have to bottle feed the baby.
In an ideal world, Panagiotou said there would be one midwife for every mother, not three for every 24, which is the case today.
The state has launched one training programme with around 20 students who are studying to become midwives and Panagiotou is calling for another programme to be launched as soon as this one’s finished.
None of Cyprus’ universities provide a direct midwifery course – instead students must first qualify as nurses and then undergo an extra course at the Cyprus University of Technology (TEPAK), which can work as a disincentive.
Either way, Panagiotou is sounding alarm bells. “The health of future society is at risk; the medicalisation of childbirth – through operations and caesareans – is affecting women psychologically and physically. How will these mothers be able to support and raise their children?”
Panagiotou also raised another serious issue: there has been a recent increase in foreign women who turn up at Makarios Hospital for the first time only when they are about to give birth, without previously visiting a doctor during their pregnancy.
“Their condition is unpredictable, without having had the various lab tests and medical examinations, and this often leads to caesareans,” said Panagiotou.
Last month, an inquiry was launched after a 29-year-old mother of three died in the operating theatre, just minutes after giving birth through c-section in a Paralimni clinic. The post-mortem proved inconclusive, though it was reported that complications arose on the operating table.
At the time, a doctor at a private medical clinic stressed that caesarean sections were actually considered major abdominal surgery and carried a maternal mortality rate up to four times greater than that for a natural birth.
The doctor added complications that could occur include infections, anaesthesia complications, haemorrhage, and injury to other organs.
Even though the head of the Cyprus Gynaecological Association, Dr George Leontiades, yesterday declined to comment, he has previously been reluctant to criticise his fellow practitioners when reports emerged over private doctors pressurising women into booking their deliveries – for financial reasons as well as matters of convenience.
“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 Leontiades.
Perinatal Health Survey
16.6 per cent of live births were fed exclusively with breast milk during the first 48 hours after birth.
Only 4.9 per cent of single births were obtained after fertility treatment, while the percentage increased to 52.9 per cent and 100 per cent in twins and triplets respectively.
Multiple births have higher rates of preterm births. From the total of all single births only 7.5 per cent were preterm, rising to 61.2 per cent in twins and to 100 per cent in triplets.
As the mother’s age increases, the rates of preterm births increase – 5.4 per cent of women aged 15 to 19 gave birth prematurely, while the number rose to 44.6 per cent among women aged 45 years old and above.
