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Why does South Africa have such a high C-section rate?

Pippa Hime
More than two in three South African Moms in private hospitals give birth via C-section – a staggering amount considering The World Health Organisation advises a maximum of 15% per country

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“I’m hoping to have a natural birth.”
“I’ve been advised by friends to have a Caesar.”
“I’m looking for a pro-natural gynae.” 

These are just a few things I hear on a daily basis. To clarify, I deal almost exclusively in the private health sector – in the public health sector I encountered predominantly natural deliveries. But why are mothers in the private health sector having so many C-sections?

In my experience, many moms start out wanting a vaginal delivery. Or at least they are planning to “try” but change their minds closer to the due date.

Most South African gynaecologists openly advocate C-section deliveries over natural birth, claiming they are safer. What this actually means is they are unable to sit and monitor each and every patient for the duration of their (often long) labour, and so would prefer a controlled environment in which to deliver a baby – in other words, a Cesarean.  

Insurance for private doctors is obscene. I stand to be corrected but I think it is in the range of R450 000 a year. You better believe that they are going to opt for the “more controlled option” – many are unable to rely on accurate monitoring during labour as a result of grossly understaffed labour wards.

In our modern times, we’re also ruled by the mantra of “I want it and I want it now”. Diaries govern the lives of many women – and men for that matter. We send meeting requests and schedule events months in advance. This applies to having a baby, too. Women like to plan their baby’s birth and even their birth date, leaving little to surprise.

Women who “try” for natural labour often aren’t allowed to try at all. They’re induced shortly after their due date and often pushed into labour before their body and their baby is ready. A perfectly healthy pregnancy can run a good two weeks after your scheduled due date. Women are also told that the baby is too big or that their frame is too small to deliver naturally.

I am well aware that C-sections are a wonder of modern medicine. I myself am grateful to a Caesarean for saving both my own and my son’s life. Having said that, after being lucky enough to deliver my first child naturally, I wouldn’t want to deny any women this truly amazing experience!


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