Wed, Feb 11, 2004 - Page 4 News List

DOH says too many Cesareans

DELIVERY DOUBTS Cesarean sections might be more convenient and profitable for doctors and hospitals, but they carry extra risks for the mother and the child


Taiwan has one of the highest Cesarean rates in the world and the Department of Health says the gap in insurance payments between natural and Cesarean births and a lack of adequate health information could be the reasons why.

"Taiwan's Cesarean rate has stayed around 33 percent for the last few years even though the WHO [World Health Organization] recommends that the figure be around 15 percent," said Huang Fu-yuan (黃富源), a member of the Department of Health's Committee of Healthcare Quality and a former deputy director of the department.

According to Huang, Taiwan ranks third, after Chile and Brazil, in terms of the number of Cesareans, or c-sections, performed each year. In 2001, for example, Taiwan's c-section rate was 32.7 percent while the US' was 24.4 percent.

"Even when compared with nearby countries, Taiwan's c-section rate is still very high. For example, Hong Kong has a 27 percent c-section rate," said Hsu Chin-yuan (徐金源), attending doctor at Mackay Memorial Hospital's department of obstetrics and gynecology.

In addition, while 30 percent of women in the US who have had a c-section opt for a natural birth in their subsequent pregnancy, only 5 percent of those in Taiwan do so," said Joan Lo (羅紀瓊), a research fellow at the Academia Sinica's Institute of Economics.

"Cesareans are necessary in certain emergency situations, but they should not be misused," Hsu said, explaining that studies have shown that c-sections often have a negative impact on the health of both the baby and the mother.

"The mortality rate for mothers who have had c-sections is as high as three times that of those who give birth naturally," Hsu said.

Lo said that birth by Cesarean section causes babies to be more vulnerable to respiratory ailments such as asthma, a common ailment for c-section babies in Taiwan especially because of the climate.

According to Hsu, of the roughly 200,000 babies born each year in Taiwan, 35,000 are delivered through medically unnecessary Cesareans.

According to a recent study commissioned by the Bureau of Medical Affairs and conducted by the Taiwan Association of Obstetrics and Gynecology, the top four reasons women choose c-sections are: to avoid the pain of natural delivery; to control the timing of the delivery and more easily arrange maternity leave, because a doctor or friends has suggested it; and because c-sections are covered by the national health insurance program.

The study drew data from the Bureau of National Health Insurance's (BNHI) records as well as from a survey of 1,600 women.

Lo said doctors have incentives to suggest c-sections.

"Because a c-section is a surgical procedure, doctors make more money from c-sections than natural births. Also, doctors don't want to have to rush back [to the hospital] to attend to natural deliveries at night," Lo said.

"Overall, unnecessary Cesareans cost the national health insurance program about NT$300 million each year," she said.

The BNHI pays medical centers NT$33,280 for a c-section and NT17,910 for a natural birth.

"The BNHI has begun a new program that will gradually close the gap between the coverage of c-sections and natural births. Hospitals, however, can choose whether to participate in the program, and so far, few have joined," Lo said.

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