Nation's cesarean section rates too high: physicians

Figures provided by the National Health Insurance (NHI) office show that women who undergo a cesarean section to have a baby are 12 times more likely to require a hysterectomy than those who deliver the baby naturally. Taiwan's rate of cesarean birth is among the highest in the world, making the findings a cause for concern, say doctors.

The report on peripartum hysterectomies was delivered yesterday at the Annual Meeting of the Taiwan Association of Obstetrics and Gynecology by a team of doctors from Taiwan Adventist Hospital and the Yangming Institute of Health and Welfare Policy, among others.

"About a third of births in this country are cesarean sections," said Jou Hei-jen (周輝政) of Taiwan Adventist Hospital, "this is roughly twice that of the WHO recommended levels of between 10 to 15 percent."

Jou and his team analyzed 214,000 non-twin births in Taiwan in 2004. NHI figures analyzed by Jou and his team showed, there were 214,000 non-twin births in Taiwan in 2002. Of these, massive bleeding or a torn uterus necessitated 287 hysterectomies.

"It's true that many of those undergoing cesarean sections had problem pregnancies necessitating the procedure," Jou said. "But many choose to have their baby through cesarean section in this country for non-medical reasons."

"Some women want to avoid the pain of labor, others worry about the birth affecting bladder control or stretching the vagina," Jou said. "Others want the baby to be born at an auspicious time."

Jou said that Taiwan's rate of cesarean births at 32 to 34 percent was high compared to surrounding countries such as Japan, with a cesarean section rate in the teens.

The US, known for its high rate of cesarean sections, has a rate in the twenties, said Jou.

Doctors often counsel women who want cesarean sections not needed for medical reasons about the benefits of non-surgical delivery, including a healthier respiratory system for the newborn. However, the women usually do not change their decision, Jou said.

"In the end, doctors cooperate because they know that if they do not, their patients will simply go elsewhere," Jou said.

"We want women to consider their options carefully, especially if it is a first pregnancy," Jou said. "A cesarean section can also render subsequent deliveries riskier as there is an increased risk of the old incision rupturing, endangering mother and baby."