Fri, Dec 06, 2002 page8

• Maternity care is a risky business

  • By Natalie Tso 竺瑞娟
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  My recent interview with the former director of the WHO's Women's and Children's Health department, Dr. Marsden Wagner, opened my eyes to the tragic state of the maternity health care system in Taiwan.

  Wagner came to Taiwan to evaluate the state of maternity care here and was shocked at what he discovered: In the past 15 years, the death rate for mothers during childbirth has not decreased, nor has the death rate for infants during birth in the past 20 years. While the fatality rate for mothers and children during childbirth is decreasing in virtually every country, why isn't it happening here?

  Wagner cited two major reasons -- the extremely high number of Caesareans and high use of induced or augmented labor.

  The WHO's recommended rate for Caesareans is 10 percent to 15 percent. In Taiwan the rate is 35 percent. Women here are not told that a Caesarean carries many risks to the mother and child, including a higher probability of dying.

  Respiratory distress syndrome is common (1 percent) among Caesarean babies because their lungs are still filled with water when they are born. Babies born through the birth canal have their lungs squeezed so that the water comes out and they are thus ready for the first breath when they are born.

  Another factor is premature births, which is more common among Caesarean babies.

  Twenty percent of women who have Caesareans will get an infection or have other complications. There is also a probability of damage to a woman's internal organs, while fertility greatly decreases after a Caesarean.

  Women are not told these facts when they are offered the choice to have a Caesarean. Ironically, many women think it's luckier to give birth this way, when this couldn't be further from the truth.

  Two years ago, there were 300,000 babies born in Taiwan. More than 100,000 were delivered by Caesarean section.

  If Taiwan kept to the WHO standard rate for such operations, 69,000 fewer babies and mothers would have been put at risk and the nation would have also saved NT$1 billion in related medical costs.

  The WHO recommended rate for induced or augmented labor is 10 percent. In Taiwan the rate is 63 percent.

  Women are given powerful drugs which lead to rapid contractions of the uterus without being told that when a woman's uterus contracts too quickly, it can lead to suffocation of the infant and a rupture of the uterus.

  Another dubious achievement is the number of episiotomies performed. The WHO's suggested rate is 10 percent whereas in Taiwan that rate is nearly 100 percent. That was the rate in many developed countries 25 years ago, but medical research has shown that episiotomies do more damage to a woman than if she tore naturally during labor.

  Episiotomies will make a women rip more, which leads to increased pain and bleeding. After delivery, there are complications such as incontinence and more pain during sex. Women in Taiwan are not told this nor are they given the choice to not have their vaginas cut open.

  Wagner was shocked at the frequency of these practices in Taiwan. The medical profession here still adheres to what was modern and high-tech 25 years ago, refusing to progress into the 21st century.

  These practices, of course, make doctors' schedules easier. So doctors enjoy the convenient fruits of high technology while mothers and babies suffer.

  Ideally, every pregnant woman should be informed of her options and the risks with each choice. In Taiwan's chauvinistic medical world, this is never the case.

  Another problem with the maternity-care system is that midwives have been pushed out by the gynecologists. In the countries with the lowest fatality rate for women and children during birth, midwives are accompanying women throughout the entire childbirth process.

  When research was done on childbirth fatality, 70 percent of the problem came from the doctor being absent when complications occurred.

  Tremendous changes need to be made in Taiwan's maternity-care system. These changes will not come from doctors, but only from women who know the truth and are angry enough to fight for better health care.

  Unfortunately, Taiwan is not a part of the WHO and will not be held accountable to its standards. However, women here are capable of making any change to ensure the rights of their fellow women and beloved children.

  Margaret Mead once said "Don't think that a small group of committed people can't change the world; they're the only ones that ever have."

  Natalie Tso is a columnist and program host with the Central Broadcasting System.
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