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Four in 10 HK babies born under the knife

  1. #1
    rani's Avatar
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    Four in 10 HK babies born under the knife

    Four in 10 HK babies born under the knife
    Alarm expressed at rise in Caesarean sections

    From the SCMP 22/3/10

    Four out of 10 women who give birth in Hong Kong now have Caesarean sections - a rate that is double the average for the developed world.

    In private hospitals, six out of 10 babies are born under the knife.

    Doctors warn of grave dangers behind the figures. Caesareans carried out for non-medical reasons are linked to a much higher risk of maternal death and serious complications, according to the latest survey by the World Health Organisation in Asia.

    Hong Kong's Caesarean rate has been on the rise in recent years, creeping up from 36 per cent in 2006 to 41.6 per cent in 2008. A WHO study in 2007 showed that the rate in developed countries was only 21.1 per cent.

    The trend is causing particular alarm in private hospitals, where mothers can freely choose the way they give birth. In 2006, 59 per cent of 25,141 women in private care had Caesareans. This had jumped to 62 per cent in the first half of last year.

    At least a quarter of pregnant women requested the operation for reasons other than medical ones, such as fung shui or fear of pain, one local doctor said.

    The average Caesarean rate across Asia is 27.3 per cent - 19.8 per cent in Japan, 35.6 per cent in Vietnam and 46.2 per cent on the mainland. The percentages for Latin America and the United States are 35 and 31 per cent respectively.

    The WHO survey revealed that the risk of maternal death or severe complications increased up to 14.2 times when Caesarean sections were done without a medical reason.

    The risk of wounds being infected is much higher, as is the possibility of severe blood loss that would require a blood transfusion.

    The study, which was published in the March 6 issue of the medical journal The Lancet, looked at 107,950 deliveries across nine countries in Asia, excluding Hong Kong.

    Unnecessary Caesarean sections had been associated with increased risks in previous studies, such as a WHO survey in Latin America. Women who had undergone a number of Caesarean sections were more likely to have problems with later pregnancies, such as stillbirths, uterine rupture and premature births.

    A spokesman for the Hong Kong College of Obstetricians and Gynaecologists, Dr Robert Law Chi-lim, said the increasing rate of Caesarean sections was a trend across the world. "More borderline cases will now go under the knife," he said.

    Private obstetrician Kun Ka-yan said there were a number of reasons behind the high Caesarean rate. Mothers were less tolerant of pain than in the past, and Caesareans had become safer so more mothers were recommended to take it, he said.

    Another factor is weight. In the past when handling large babies, doctors would only perform a Caesarean if it weighed more than 4kg. They are now often performed if it weighs 3.7kg. The same applies to breech births, in which the buttocks or feet are delivered first. In the past such these were delivered naturally.

    "Fewer babies are born these days. Whenever we have a minor doubt, we tend to play safe and do a Caesarean," Kun said.

    Kun said another reason was that more mainland mothers now give birth in Hong Kong. "They only get a permit here and cannot stay in Hong Kong forever. Many of them would like to complete the whole process of giving birth and getting identity documents within one week. Caesareans are more predictable."

    But 70 to 80 per cent of elective Caesarean births were due to fung shui, the doctor said. Kun said that while he would explain to his patients the risks of going under the knife, it was ultimately the mother's choice. "Even if I refuse to do a Caesarean, another doctor will do it."

    Fung shui master James Lee Shing-chak said he was approached by more than 100 mothers a month for advice on the best day to deliver their babies.

    "Some of them want their babies to be born with an emperor's fate, some of them just want to avoid the unlucky days," he said.

    Mothers tended to avoid festivals associated with deaths.

    But Lee said the choice was sometimes limited as doctors might not be willing to deliver the baby at the time chosen. "Some do not want to wake up too early or work too late, and some do not want to do it on Sundays," he said, adding that some mothers would change their doctors as a result of this.

    Lee reminded mothers that it was against "heaven's will" to choose their babies' birthday. "These babies will have a lower emotional quotient because their mothers did not bear the pain in a natural delivery."

    One mother who is opting for a Caesarean section is due to give birth at St Teresa's Hospital in Kowloon City early next month. She has chosen April 4, Children's Day, to be her baby's birthday.

    "I mainly do not want to go through the pain [of vaginal delivery]," she said, adding that she was not aware that a Caesarean might be riskier.

  2. #2
    Monty is offline Registered User
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    Thanks for posting this Rani.

    I gave birth in a private hospital on HK island late last year and as far as I was aware I was the only woman there that had a 'natural' birth. Every woman in my ward (6 bed room) had c-sections. The midwife told me it was because these women like to be able to pick an auspicious day for their babies to be born. She told me that I was the exception (vaginal delivery) not the rule. She even asked me why I was not having a c-section. So too did the lady at the admissions desk, and the nurse that completed the check in procedure. We also ended up being charged, per hour, to use the labour and delivery room as the 'package' only included the use of the labour room for one hour (even when opting for the 3 day package for a vaginal delivery).

    I found the whole process quite disappointing. Not that they were electing to have c-sections but because they were coming in, having their c-section and then staying in their beds without any contact with their new babies. The babies were in the nursery, being fed bottles of formula, whilst they slept the days away. I too was the only woman in the whole hospital that was exclusively breastfeeding (but that's another story!).

    I find it particulary crazy the part about not wanting to go through the pain of a vaginal delivery. C-sections require epidurals (or spinal blocks) and these are freely available to women who choose to have vaginal deliveries as well. A vaginal delivery need not be painful with an epidural. Surely the quicker recovery from a vaginal delivery should be considered as well?

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    lisa88 is offline Registered User
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    There was an article in the SCMP last year reporting studies in the developed world about the increase in elective C-sections and titled "Too Posh to Push"? Very apt title. Sounds like yesterday's SCMP article just confirms the wider empirical study.

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    jvn
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    Thanks for posting, it's an interesting article. I have very mixed feelings as personally am pro-natural everything within reason (although I appreciate that everyone's definition of 'within reason' varies too).

    However, I'm also very pro personal choice and personal responsibility, the article focusses on women who are giving birth in private hospitals in various countries across Asia and I just don't know if the information about the risks associated with elective c-sections or benefits of breastfeeding etc.... are as widely available in their mother tongue as they are to English speakers.

    I know there is an example at the end of one woman who did not know about the risks but is this widely the case? If these women are making well informed decisions then personally I feel I have to respect that, if however this is not the case then these women are being done a terrible disservice by the medical profession in that country.

    It's not that long ago in England that mothers were sometimes treated quite dreadfully by the medical profession when they went into hospital to give birth, I know my mother had a pretty bad experience first time around which is why she went for a homebirth with me ;-) I think it's possible that these "don't want the pain of natural childbirth" people are reacting to terrible stories of how their own mothers or relatives were treated 20 or 30 years ago and going for what seems to be the "easiest" option to avoid that.

    At the end of the day now that women have more choices, I believe that no-one could or should take them away from us but it's worrying to think that decisions might be being made based on little or no information or indeed the wrong information.

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    matemate is offline Registered User
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    monty, which hospital did you go?

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    Gataloca is offline Registered User
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    I guess there are also lot of unscrupulous doctors, that would try to scare and give inaccurate information to their patients so that they would go to C-section directly.

    One of my colleague delivered here baby at Canossa (I think) last year via c-section. She said that her doctor told her that it would be very painful for her if she tried to have a vaginal delivery. Don't know about the reason, but it really sound that her doctor was just trying to scare her about the pain.

    Another case (but long time ago) back in Venezuela, one of my colleague delivered via c-section because her doctor told her that a vaginal delivery would stretch her vagina, and may interfere with her sex life in the future.

    Some doctors also seem to prefer to do c-section because the timing is more predictable, gives them less work, and they get a higher fee from the surgery.

  7. #7
    rani's Avatar
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    In my Due Date group, there were 7 of us and only 2 of us had vagina births.

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    baffelly is offline Registered User
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    I agree with jvn that if the technology is available and affordable, it's a good thing that the women have a choice. I feel bad for moms who think they did sth wrong by choosing c-section. Nonetheless it is an useful reference article. Though I don't think the quote that babies will have lower EQ because moms didn't suffer the pain has any scientific support and is rather absurd.

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