Cape Town A new investigation into Caesarean-section deaths shows that this method is dogged by problems and could be riskier than natural birth.
C-sections are generally regarded as a safer method of delivery, with many birth experts opting for them in emergency situations as an attempt to save the lives of mothers and babies.
The latest research on maternal deaths in the country by Stellenbosch University, UCT, Mowbray Maternity Hospital and the University of KwaZulu-Natal not only linked C-sections with problems such as excessive bleeding, and clotting, but it also revealed that the risk of dying in the past three years was almost three times more compared to natural birth.
This data raises concerns as the rate of C-sections is on the rise.
According to the 2013/2014 district health barometer published by the Health Systems Trust – one out of four women deliver their babies via C-section, with almost 24 percent in the public sector and 74 percent in the private sector. This number has doubled compared to a national rate of 12.5 percent in 2000/2001. In the private sector, gynaecologists and obstetricians had argued that they were increasingly performing C-sections to avoid the risks associated with natural births.
Analysing the 2011-2013 Saving Mothers report of the national committee for confidential enquiries into maternal deaths, researchers found that while the number of C-section deaths was lower at 1 243 compared to 1 471 natural birth deaths, there were more avoidable deaths in the C-section arm.
Problems such as lack of surgical skills, poor communication between surgical and anaesthetic teams, inadequate pre- and post-operative management of patients, ambulance delays, and internal bleeding following surgery, were some of the problems contributing to poor maternal outcomes.
Lead researcher and senior lecturer at Stellenbosch University, Dr Stefan Gebhardt, argued that even though the indication to perform a C-section was often an attempt to save lives, the deaths were an “area of concern and a concentrated effort is necessary to make these C-sections safer”.
Most women died at district level hospitals, many dying in the ambulance before, during or after referrals from hospitals. He said this reflected reluctance to perform necessary surgery due to ambulance delays, insufficient blood supplies and lack of surgical competence at district hospitals.
There was poor response to deteriorating vital signs by nurses and doctors, and doctors often gave telephonic advice rather than assessing the patient. Referral for post-C-section bleeding was often arranged rather than an abdominal exploration. Even though internal bleeding was the most common in post C-section, symptoms were hardly noticed in time, resulting in unnecessary deaths.
Gebhardt said while doing more C-sections didn’t necessarily lead to more surgically related deaths, efforts should be made to reduce the number of deaths associated with the procedure.
“Medical students are ill-equipped to do surgery after graduation, yet they are expected to do a major invasive procedure in women with complex, altered physiology where complications that can challenge even a highly skilled doctor can arise within seconds.”
sipokazi.fokazi@inl.co.za
Cape Argus