x Abu Dhabi, UAEThursday 18 January 2018

Do you want a 12/12/12 baby? Or how about a natural delivery?

It is important for us to tackle the reasons for planned C-sections, and one-to-one education about the benefits of a natural delivery would help to deal with this critical health issue.

While the UAE has caught up with the economies of the West in a mere 41 years, it has also caught up (and in some cases surpassed) the West in the side effects of development. Although the majority of the population is young, the prevalence of cardiovascular disease in the UAE is among the highest in the world.

Similarly, the country also has very high rates of Caesarean sections, despite universal recommendations about natural births in the absence of complications.

In the UK and the US, the proportion of C-section deliveries has doubled over the last 20 years to 25 per cent and 30 per cent respectively. This is because of an increase in both emergency and planned C-sections, with approximately two-fifths of such procedures planned in advance.

These rates are much higher than the target of less than 15 per cent, which has been recommended by the World Health Organisation. There is a threefold increase in complications, an increased cost and a risk of antibiotic resistance associated with C-sections compared to natural births.

The UAE's rate of C-sections is comparable to that of the US at about 30 per cent - and also on the rise.

There is no doubt that certain situations necessitate the procedure. For example, there are some conditions that may warrant it: cephalopelvic disproportion (a mother's pelvis is too small for the baby's head); malpresentation of the baby (the baby is not lying "head down" in the womb); multiple pregnancies (twins or triplets); the mother has very high blood pressure; foetal distress during labour; failed induction of labour; two or more previous C-sections; maternal infections that are more likely to be passed on to the baby during a normal birth; and pelvic cysts or fibroids.

With the increased number of routine maternal prenatal checks and the now-commonplace electronic monitoring of the baby's heartbeat during labour, many more candidates are filling the criteria.

However, there has also been an increase in the number of C-sections because of patient choice. This is because of a number of factors, such as an extreme fear of the pain of labour, the uncertainty associated with the timing of labour, and the will to have a baby on a certain "auspicious" day - such as today, December 12, 2012.

Unfortunately, these reasons ignore the recommendations of the Royal College of Obstetricians and Gynaecologists in the UK, which state that as long as it's safe for mother and baby, natural birth is the best way to deliver. Babies born naturally have a decreased risk of being admitted to neonatal intensive care units because the physical stress on a baby's lungs during labour helps them to adapt to breathing after they are born. In addition, a natural delivery is associated with a decreased hospital stay for both mother and baby, and a decreased risk of a mother's emergency hysterectomy or cardiac arrest.

Although having a C-section avoids the pain of labour, the recovery time is longer and it is more detrimental in the long run. Although common, the procedure is considered major surgery and carries the associated risks of bleeding, infections and blood clots.

Another interesting point is that if a mother plans to have more than two or three children, a C-section increases the risk of mortality in subsequent pregnancies. In addition, a mother is more likely to require an emergency hysterectomy with a C-section, with the end result being infertility.

Some C-sections are medically necessary, and are responsible for a downwards trend in infant mortality. However, in the absence of complications, natural delivery is the best way to deliver both for mother and baby.

It is important for us to tackle the reasons for planned C-sections. In the UK, women who choose a C-section because of anxiety associated with labour are referred to perinatal mental-health professionals. A similar system with one-to-one education about the benefits of a natural delivery would help the UAE to deal with this critical health issue.


Jomana Fikree and Cother Hajat are physicians and academics based in Abu Dhabi