Caesarean section deliveries are more common in Hong Kong than in most
developed countries, but do we know why?
Jill Mortensen
investigates.
T
he sensation of my
firstborn entering the
world after we each
did our part to make it
happen was the most empowering
experience of my life. That was why
I was devastated when my second
baby was breech, unable to turn and
destined for a Caesarean section
delivery. I know I made the right
decision based on medical research of
breech presentations, but the recovery
after this major abdominal surgery
was horrendous compared to my
first delivery, and it still bugs me that
someone else took over my job.
There are pro-Caesarean women
who either are “too posh to push”
or want to schedule a birth within
a limited timeframe for maternity
leave and visiting relatives. And in
Asian cultures, many women prefer
a scheduled Caesarean to secure the
most auspicious date for the child’s
destiny, as advised by a feng shui
master. These women are usually at
peace with their decision.
But there is a large group of
women who accept a C-section
diagnosis without a clear medical
reason and then never quite recover
psychologically. They regret
surrendering to the pressure from
doctors and hospital staff. Critics of
this soaring trend have suggested that
our society’s casual acceptance of non-
medical surgical procedures is fuelling
a business for C-sections.
Financial incentives?
“When I was six weeks’ pregnant,
my doctor told me that because I was
small and my feet were small, I would
probably end up having a Caesarean
section,” says Jenny, a young and
healthy mother of three. “I told him
all the way through that I wanted a
natural birth and not a C-section.
When I was 39.4 weeks, he told me
that because the head wasn’t properly
engaged, I would most likely end up
having an emergency C-section, so
why not just schedule an elective one?”
Jenny started natural labour
a few hours before that scheduled
Caesarean section but wasn’t offered a
chance to try to deliver naturally. The
same doctor automatically scheduled
Caesareans with her second and third
pregnancies. The babies weren’t any
bigger than normal, with Jenny’s first
baby weighing 3.59kg at birth, the
second weighing 3.03kg and the third
weighing 3.29kg – all average-sized
newborn birth weights.
“I knew Hong Kong was
C-section central,” says Jenny.
“Looking back, I don’t feel it was
necessary for the first two and
subsequently wouldn’t have been for
the third. I would urge others not to
be as weak as I was with my doctor. I
wish I had been strong enough to fight
for my choice.”
The 2008 documentary
The
Business of Being Born
treats birth choice
as a women’s rights issue and suggests
that maternity care decisions in the
United States are driven by physician
and hospital convenience and financial
gain. In fact, starting in January
2014, the organisation that accredits
American medical institutions will
mandate that hospitals implement
strategies to decrease the Caesarean
section rate in low-risk women. No
such regulation or monitoring system
exists in the Hong Kong private sector,
where hospitals and doctors can have
Caesarean section rates exceeding 50
per cent and remain unchecked.
The World Health Organization
states that any country in the world
C-sectıons
The business of
November 2013
61
