STACEY GREAVES-FAVORS
| The Saudi Cesarean Epidemic |
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| Sunday, 06 February 2011 10:16 |
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MY research for birth statistics in Some of the quotes from that report include: Whoa! The cesarean rate has increased by 80% in just ten years?!? That's a terrifying epidemic from my perspective! Delving deeper I found that the cesarean delivery rate in 2006 was at 19.1%. Although this is lower than the American average, it is still above the commonly known recommendation by the World Health Organization that caesarean deliveries should not exceed 10–15%. Anytime I discuss cesarean deliveries I must first give credit to the procedure and the skilled doctors who perform them when there is a health or life threat to the mother or baby. But I also have to wonder how many of those surgeries were really necessary? I feel compelled to list some of the increased risks associated with the cesarean delivery: There are many more risks than I've listed here. One such additional risk is the increased need for cesarean delivery in future pregnancies and the associated risks of uterine rupture that comes with repeat pregnancy after cesarean delivery. This is especially noteworthy in I read a commentary in the October issue of Ob/Gyn News titled: The Cesarean Section: A View From the Trenches, written by Dr. David M. Priver, M.D. This article had some interesting things to say about why the cesarean rates have increased, from the practitioner's perspective. I have paraphrased his theories for you here: This mirrored my experience in discussing cesarean rates with obstetricians I know personally. One such obstetrician told me that the "art" of obstetrics is being lost to the "knife." In the article Why Are Nearly a Third of Childbirths Cesareans?, an article from my new favorite blogging doctor, Dr. Mercola, says the following: When considering the reasons behind cesareans both Dr. Mercola and I suggest the That last statement rings so true of my personal experience working with an obstetrician. May Allah reward her as she has learned from me about natural birth and begun to put it to use in her practice. (See next week’s article to know more of her transformation.) However, prior to our friendship, she was recommending ELECTIVE cesareans to her patients. She felt it was a "mercy" to "spare" them the pain of labor and delivery. She also admitted that it was easier for her as she didn't have to see her patient in pain. (Think about that...it was easier for HER, the doctor, because she didn't have to see the patient's pain. What about the long lasting pain AFTER the surgery? What about the increased risks? Who gets stuck with that? Not HER, but the new mother!) When I met her husband he asked me, "What have you done to my wife? All she talks about now is the Bradley Method® and natural birth. Before she used to do cesareans and be gone for 45 minutes for a delivery, and now she leaves the house for hours on end; plus she brings home less pay!" What's sad is that this man is a doctor too! Although not in obstetrics, thankfully. This all brings us back to the earlier quote, "A national strategy to reduce the CD [cesarean delivery] rate is needed..." (I told you to remember this comment.) In Dr. Priver's article, noted above, he says, "...we might wonder why obstetricians are paid...more – for doing a CS [cesarean section], which involves an expenditure of 30-45 minutes of time, as opposed to guiding a woman through a labor and vaginal delivery, which often requires infinitely more judgment and skill. Consider what would happen to the CS [cesarean section] rate if obstetricians were paid $800-$1,000 more to accomplish a [non-medicated] vaginal delivery..." Now there's an idea worth considering! I'd be the first to line up doctors and teach them how to work with their patients using the Bradley Method® to achieve completely non-medicated births, insha'Allah. I'd be eager to train others to be teachers in order to reach the millions of women whose births this type of change could effect. How about taking it a step further and providing a monetary reward to the mothers who achieve a totally natural birth? Now that would be a happy ending to this story, don't you think? ©2011 aisha_alhajjar@yahoo.com, All Rights Reserved (All writings are the original work of Aisha Al Hajjar and are based on her personal research, experiences, and opinions; they do not necessarily reflect the views of The American Academy of Husband-Coached Childbirth®, The Bradley Method®, or this publication. |
Comments
I know of instances in which people were unable to obtain pain medication to undergo surgical procedures in Saudi while awake. These medications are regulated. One person was given aspirin (in a painful shot form) to get a wound scraped and another one endured kidney stone blasting with next to no medication. Maybe all the cesareans have to do with avoiding the use of certain pain medications and even epidurals? Anesthesia for cesareans would not present this issue, I assume.
If you are interested, look into a connection there. I can almost guarantee there is some connection with Saudi hospitals being unwilling and even unable to serve patients in terms of pain management.
Thank you for taking the time to read and comment.
I'm saddened to hear about the medical procedures you mention being done without the seemingly appropriate pain management.
Ironically, it is just the opposite (in my opinion) with childbirth. I feel that pain medication is given like candy and even pushed onto mothers without a real trial or assistance in natural pain management techniques.
I teach natural birth and encourage mothers to learn how to cope with the pain of labor without drugs or medical interventions so long as everything is going normally. Most births are normal, yet we rush to intervene, speed nature, and medicate women.
I pray for anyone who has to undergo medical treatment of any kind, and especially for women who are treated medically for a natural event that should be watched and monitored (but not intervened in)...birth. May Allah protect us all with proper use as well as proper avoidance of medical technology and drugs...ameen!
Best regards,
-Aisha, Natural Mom
Personally I used the Lamaze method in labor, which involves getting through to about 7-8 cm dilated before having any medication, because any sooner, and the process is often slowed down. So you are correct, if medication is doled out too soon anbd too liberally and Lamaze not taught, it will definitely lead to more needless cesareans. Women who know what the procedure truly involves, would be right to be terrified and want to avoid it if at all possible. It should not be taken lightly or done unless at the end of need. You are a wonderful woman for publishing this important information and starting dialogue on this important issue.
It's terrific that you had the advantage of Lamaze training! Childbirth education of any kid is virtually unheard of in the Middle East.
Personally, I teach the Bradley Method(r). It is similar to Lamaze in some ways, but differs in the respect that we teach natural relaxation techniques, coupled with a trained "coach" (usually the father), and avoidance of all drugs throught the ENTIRE labor and birth.
Wait until the end, as you mention, is far better than taking meds from the get go...but still misses the mark in terms of non-medicated birthing. All medications reach the baby within 60 seconds and NO medication is guaranteed safe for the unborn child. In my personal opinion, if you make it that far into the labor...why risk it now?
There are so many risks with the drugs given for pain relief that it simply isn't worth the few hours or minutes of relief...again, in my opinion.
I commend you and any mother who delay drug use as long as "possible." But I also feel that with a little more preparation (physically, mentally, and emotionally) that most women could probably finish the job without it as well. (My two cents worth.)
In the end, healthy baby, healthy mother is what matters most. There's no doubt we all want what's best for both.
Best regards,
-Aisha, Natural Mom
Many thanks for bringing this important subject to people's attention. Cesareans have really become an epidemic in many parts of the world, especially medically unnecessary ones.
Last spring I became pregnant with my first child while having been living in KSA for about a year. I started doing some research about my options here, birth facilities, home delivery, medication during labor and so on. I was shocked by the stories I heard from women who had given birth in hospitals in KSA. Elective cesareans, medication during labor without prior consent by the mother, nurses that are overwhelmed by the number of patients... I was sure that I didn't want to give birth that way.
So I went back home to Germany, where midwifery is a fundamental part of birthing practices. In Germany every birth has to be accompanied by a midwife, BY LAW, whereas the presence of a doctor is optional. Midwives there have a strong background in natural medicine, herbs, accupuncture etc.
I had a wonderful natural birth there and can only recommend this special experience to every woman who has no medical issues preventing her from having an unmedicated birth. A natural birth is so empowering and one of the fundamentals of womanhood, in my opinion. But in order for it to be a positive experience you really need to be in the right state of mind mentally, and you need someone with you that you trust and that is very close to you. And you need time of course, cause it takes as long as it takes.
By the way, medicated, unnatural births are just the tip of the iceberg, I think. It goes on with mothers being talked into not breastfeeding their babies, or doing so for just a few weeks, and instead feeding them artifical food, based on cow's milk. And many also think it's healthy to start with complementary food very early, maybe because they are afraid breast milk is not enough and because they want their babies to gain a whole lotta weight in a short time, because they think weight is the main indicator for the baby's health. Supplementary foods, such as Babylac, Cerelac and the like are also very popular, as they are thought to have lots of vitamins and minerals.
People really seem to have forgotten the value of natural breast milk. And not many have the patience nowadays to wait until their babies show interest for complementary food, which is the time when their stomachs are ready to digest food other than milk.
I hope you will be able to have an impact on birthing procedures here in KSA, with Allah's help inshallah. It's really so important.
Wa alaikum salam
JZK for reading and taking the time to comment. Alf mabrook on the birth of your baby. May Allah bless and keep her/him and may he/she be pleasing to HIM and his/her parents...AMEEN!
I love the midwifery model of care in Germany and other European countries. I dream of the day that all births are under such a gentle and natural system of care. I have hopes for a changed birthing culture in the Arab world and with a lot of work and prayer, anything is possible, ya Rab!
You are absolutley right, it goes beyond birth to breastfeeding and parenting in general. As for birthing and feeding it really boils down to trusting our Creater and the perfect design of our bodies and trusting in HIM for our babies' provisions at the breast. Unfortunately, as time has passed we have come to an era and culture where we doubt these very basic truths of perfection of creation, audthobillah.
Thank you so much for sharing a bit of your story and I'd love if you would consider writing it for publication on my Saudi Birth Story blog. (www.saudibirthstory.blogspot.com) The blog contains stories from Muslima mamas around the world and I'd be honored to include yours, insha'Allah!
Please help spread the word by sharing this Motherhood column on Saudi Life with others in your e-circle. JZK
Salam alaikum,
-Aisha, Natural Mom
Your software sounds intriguing. I don't quite understand how it works but would love to learn more about it.
Best regards,
-Aisha, Natural Mom
This should give you a good start and once you feel comfortable with the Cesarean Rate History you can read about the Cesarean Rate Tracker which is what I think will become the gold standard for comparing the effects of different labor management strategies.
Best regards,
-Aisha, Natural Mom
I just read this article now cos I am preparing my article for why this increase in CS rate in Egypt.
I am the doctor who Aisha talk about, but I want to add my comments
First: from my opinion as obstetrician we do not recommend CS for time or money (not all Ob)
my self I did it for a medical reason from my perspective but after I knew Aisha I have a great change in my practice. I was really consider pain medication is a mercy from Allah but now after I learned a lot from Aisha and the Bradley method I do believe birth companion can do more than pain killer.
from my point of view the first and most important cause for this epidemics is lack of knowledge and experience about natural techniques to manage labor and birth from Ob and mothers Ob didnt learn that in the medical school they never see natural birth even Ob female doctors have very high rate of CS when they have their baby cos they never see the natural process
second cause is ignorant mothers and lack of knowledge and difficulties to listen to Ob when we talk about natural birth mothers and mothers in law are great obstacle to me I lost many cases who attend classes cos they didn't believe natural process and people around them affect their decision
You know I love you so much! I have learned so much from you, as you have from me, alhamduelelah.
I'm so glad to see your comment here. You know that I was shocked when you told me that you had been recommending Cesarean to your patients before you met me. I was also shocked to learn (not only from you) that most OBs have never really seen (nor been taught about) natural birth. This never occurred to me, and frankly, I find it quite troubling and an overwhelming failure of our medical model of maternity care.
We can't blame doctors. As you stated, your training in medical school is sorely lacking the important element of normality and the natural function of birth as we were created to experience it. In turn, women who are now subject to the medical model of birth, have lost touch with birth as a normal, natural function and what is passed down from the older generations of women to the younger is now this twisted medical model of abnormality and helplessness, rater than normality and natural empowerment of our great grandmothers and millions of women before.
As an OB, you are taught that your are there to rescue women from their pain, to numb or wipe out the experience, and to relieve them of their burden. Unfortunately, you are not taught to empower them or encourage them to trust and work with their bodies, but instead are schooled in the management and control over them.
This truly is the dilemma of the era. The wrong turn which medicine has taken in an effort to control birth. Birth is an event, not an illness. It needs to be experienced, not cured. It needs to be conquered by mothers, not controlled by doctors. It is an event that needs encouragement and empowerment, not control and management.
To truly balance things, we need to educate women and birth attendants alike. We need to understand the process from a natural perspective and employ the many natural techniques that make birth not only bearable but enjoyable and empowering. Obstetricians need to return to the root of the word obstetrics which means "to observe". Quiet observation to manage rare complications should be the role of the birth attendant, not routine interventions which inadvertently lead to the complications you are so skillfully trained to control.
Thank you, Dr. Hanaa, for your input. Thank you for sharing your perspective here on this page. Thank you for letting me be a part of your personal development and for showing me the picture through an obstetrician's vantage point. All of this, here and today and everything between us which has led to this point, is clearing the fog of my vision as to what my role is/should be and where I need to focus my energy and attention.
I love you, my sister! May Allah bless you and the many women you reach with your new-found understanding and passion for natural birth! Keep up the good work and, insha'Allah, we will meet again soon, as I have new and bright ideas for the work we must do together for all women and the doctors who care for them!
I do need your help and support and you know just how well we work together!
My best regards to you and dua for you and your family,
-Aisha, Natural Mom
I remember one day 18 years ago I was asked why you choose Ob as your career I replyed that I like this job who deal with that pleasurable event holding the baby immediatly after birth and giving him to his mother but when I went to my training I couldnt beleive what I see I hate prgnancy and birth and when I got pregnant I didnt sleep nights can that happen to me is that birth until really I apply what Bradley teach the first time I enjoyed birth the first time I wish to have a baby after 12 years I refuse even to talk about being pregnant.
you knew Aisha when we start our work no one of my college even want to listen to you when you talk about natural they told me that we are crasy look at them now they want to help they beleive but still they couldnt try natural process
what I am planning to is to teach different skills of natural process that can help Ob and nurses to trust natural process
every time I went to hospital for natural birth nurses deal with me as a creasy doctor and after natural birth they all happy and couldnt beleive it happen as simple as that
miss you so much miss working with you you know Aisha how mach I love you as a sister and friend Doaa for you to have our dream BIRTH CENTER
It really saddens me that birth has been turned into a trauma and drama by the medical training our doctors receive. We really are missing a huge link in the birthing culture by skipping this important piece of maternal care.
Absolutely, we NEED the management and surgical skill of Obstetricians...but putting these skills to work in the majority of births is overkill! As you have learned, it also costs women and babies the best start in life and in some cases even kills, literally. :(
I am so happy you have stuck it out and are showing others. One birth at a time we make a difference, but it's time to make it one doctor at a time which means hundreds or even thousands of births at a time, insha'Allah.
May Allah bless you and keep you going! We will talk soon about our next steps, insha'Allah.
Jzk to your duas my dear sister!
All the best,
-Aisha, Natural Mom
Do they allow women to move around during labor? Do they keep women off their backs in labor? Also in delivery? As well as out of stirrups? Do they fore go routine IVs, fetal monitors, vaginal exams, pain meds, AROM, labor induction and augmentation? If so, I'm thrilled for the women of your hospital!
If not...they are doing unnecessary interventions which inevitably can lead to cesarean (although not unnecessary...just iatrogenic...doctor caused).
I totally agree with you that education and preparation (physical, mental, and emotional) including diet, exercise are key!
I would not say doctors in Saudi are not trained. They are very skilled surgeons, trained in abnormality. The trouble (like many other places in the world) is that they are so keen to abnormality that they can lose (or never had) a sense for normality. In fact, most doctors here (and other places) never see a totally natural (not just vaginal, I mean unintervened) birth during their training or after. It's not their fault...it's what they are taught. (I'd love to be in contact with natural birth advocate OBs from any part of the world.)
In and of itself, 42+ is not contradictory to childbirth, nor is large babies...although an out-of-shape mother who is not allowed (or unable) to move around during labor and birth certainly can be precluded from a truly natural birth.
Truth is, many mothers don't even want a natural birth! Some opt for surgery or simply don't take the time (or aren't aware how) to educate themselves or get prepared.
It's good news that you feel confident in your job and with the staff you work with. I pray women of your region are having the best birth experiences possible...in fact I pray for this for all women...and sometimes that does mean cesarean. However, the current numbers do indicate that surgery is far too common than is truly necessary...but in the end, healthy mother and baby and qadr Allah!
Best regards,
-Aisha, Natural Mom
to answer your questions.. the hosp i work in pretty much caters to whatever mother wants. most parents go to a lamaze class. I'd say 95% do. Women walk around during labor ( we do even have walking epidurals for those that demand it) , in fact walking is encouraged, delivery is in any position you choose, we rarely use stirrups, there are new birthing chairs now
fetal monitors are at admissiont ime only adnthen taken off, again it all comes down to education and what the mom wants.
I was telling my last patient she could do it without pain meds since she was clsoe and encouraged her to sit inthe tub if need be or take a warm shower.. nada.. demanded an epidural and when it was too late for that asked for painmeds.. at that time education is not appropriate, keeping the mom cool is , so i gave it and helped her to it. I think the policy should be anything as long as it makes the experience happy fro the mom and does not endanger the mother or child..
My last mother prefered to have the fetal monitor at all times ???? i have no idea why.
I also have moms who demand and epidural, sleep happily and deliver pain free
It's my goal to reach women early, as you said, labor is not a good time for this!
Of course, even in labor, women need true informed consent, not just lip service...many are given misinformation or no information...as if they are not capable of knowing the truth about things.
The "doctor knows all and you don't need to know" mentality is dangerous!
Prenatal education and caring labor support (which includes great nurses) go a long way to ensure the best start in life! Keep up the good work, Sister.
Best regards,
-Aisha, Natural Mom
Thanks for this great article. I am a father of two children, who's first child was delivered by CS and the second through a natural birth. My first child was born in Egypt and at that time I wasn't aware of the CS Epidemic existing Arab countries, I am originally from Germany. So without any reason the doctor rushed to CS although labour started. We trusted her as she is the doctor. But after the birth we asked for the reason but she couldn't give us any medical reason. And we came to know that this doctor is known for CS. My second child was born in Saudi Arabia. But here we didn't want to repeat the mistake in just "trusting" the doctor. We informed us on the internet and through relatives and we emphasized in every appointment we had with this doctor that my wife prefers a natural birth and she don't want CS unless there is a severe medical reason. And of course, we informed us about her before we choose her as our doctor. Allhamdulillah, my wife delivered our second child through natural birth. She recovered very fast, unlike after the birth of my first child. We recommend every mother and father to inform themselves about the doctor they choose and her/his CS "rate".
Thanks again for this great article and we make Du3a that Allah will give you success in increasing awareness in Saudi Arabia about this topic and promoting natural birth.
Wassalamualeiku m
Thank you for taking the time to read and comment. Cesarean rates are epidemic the world over, unfortunately. The biggest problem here is lack of parental education and no real informed consent.
You give very good advice about asking the doctor's CS rates! Jzk for sharing.
I'd love to share your VBAC (vaginal birth after caesarean)story on my blog (www.saudibirthstory.blogspot.com), if you'd care to share it. Not only is it a great story as she had VBAC in Saudi, but it's rare I get a father's perspective!
Email me at aisha@saudilife .net if you are willing to share.
Best regards,
-Aisha, Natural Mom
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