Is the steep rise in Cesarean sections a lucrative business?

Photo: Oriol Martinez / freeimages

In recent years there has been a steep growth in the number of Czech women giving birth by Cesarean section. While in 1990 one in twelve women gave birth by C-section, today it is one in four. A similar trend can be seen in other parts of the world and the World Health Organization has been increasingly critical of what it calls C-sections-on-demand. According to WHO statistics a fifteen percent C-section rate is within the norm, and approximately 40 percent of all C-sections performed are medically unnecessary. So have C-sections become a fashionable trend in the developed world, or, as some argue –a lucrative business? I spoke to one of the country’s leading obstetricians, Vladimír Dvořák about the steep increase in C-sections and the reasons behind it.

Photo: Oriol Martinez / freeimages
“First of all, I would like to say that we can see this situation not only in my country but all over the world. It is a tendency and I do not think that the Czech Republic is an exception. So this increase of Cesarean sections can be seen in all countries, or almost all countries with developed health care systems. There are certainly more reasons for this. One of them is that women have more information from the Internet and some of this information indicates that a C-section could be –from certain points of view – safer for the baby than a natural delivery. Some of them also say that it is more comfortable when they know the exact date and hour when they will deliver. In such a case they also know that the obstetrician, pediatrician and anesthesiologist of their choice will be present. So that is one of the reasons.”

Are you saying that they ask for a C-section and get it?

“Many women really ask for a Cesarean and it is very difficult to argue with them and to say, no we will never do that. Because then, if some complication occurs it could be potentially dangerous for the obstetrician. And that is another reason why we can see this increasing number of C-sections, because obstetricians and gynecologists are - at least in my country- most frequently dragged into lawsuits. So they are getting more and more careful and it is safer for them to perform a C-section.”

Does that mean that most Czech hospitals would meet such a demand – or all of them?

“Not all of them, but in most of the OBGYN clinics you can see an increasing number of C-sections. Still, the increase is comparable with other European countries or with other countries with a developed health care system. ”

I suppose it also has to do with the fact that women in the developed world now give birth much later in life?

“That is also one of the aspects. Now many women deliver just once or twice in their lives and postpone having a baby until their mid-thirties. And these women want as safe a delivery as possible. So yes, that is another reason behind this trend. ”

You say this is a trend in the developed world. What do you hear at international conferences – approval or disapproval? Or are doctors divided on whether it is good?

Vladimír Dvořák, photo: Czech Television
“We cannot say it is good, but we have to accept it. It is very difficult to do something against it. I think that most obstetricians are not happy with this tendency but they just accept that and they do what they have to do. So I think that this is what you can see at international conferences. There are many discussions what to do, how to make the number of C-sections lower, but I do not think it works in most of the countries. ”

As an obstetrician you say that you – and most of your colleagues – are not happy about this trend. From a medical point of view in what way is it negative – as regards the health of mothers and future pregnancies? If a woman were to come to you and ask for a C-section what would you warn her about?

“It is very difficult. You must consider the risks and benefits of both methods. The C-section is surgery which always involves some risks, minimal risks but they are always there, like risks from anesthesia, there are risks even from epidural anesthesia. On the other hand, spontaneous delivery is maybe a little bit more dangerous for the baby. The woman is a little bit more uncertain about when it will come, who will be there, it could be at nighttime and so on. And of course there could be complications after a spontaneous delivery as well such as urinary stress incontinence or some sexual disorders. So both ways of delivery have their benefits and risks and it is very difficult to say that one of them is definitely safer than the other.”

Giving birth by Cesarean section is also a lot more expensive and we hear from critics that it may be becoming a business, that that is why so many hospitals offer it. What would you say to that argument –do you believe that to be true or false?

“I think it could be true in some health care systems, but I do not think it is true in the Czech Republic. Because actually the amount of money that insurance companies pay for a Cesarean section is not that much higher than for a spontaneous delivery and that makes it more expensive for the hospitals, so I do not think that hospitals have a bigger profit from a C-section than from a spontaneous delivery - if you count all the expenses. So I do not think that is the case in my country. It could be the case in some other country with a different health care system.”

Photo: Kristýna Maková
As we said there has been a steep jump in the number of women who give birth by Cesarean section –in the Czech Republic it is now 25 percent of all births –ie. one in four women. In 1990 it was 1 in 12 women who gave birth by C-section. There is a similar trend across the Western world –will this grow further in the years to come? Will natural labour become the exemption rather than the norm at some point?

“I think no one knows that. The tendency is clear, but I think any future increase will not be as big as it was in the last twenty years. But a slight increase in C-sections is something we will see all over the world –or at least in most countries of the world.”