Taiwan has had one of the world's highest Cesarean-section rates for the past decade, but the government has done little to redress the situation. The preliminary results of a recent large-scale study commissioned by the Department of Health (DOH) should be used to help map out new policies. If the government, the medical profession and academics already agree on the need to reduce the number of C-sections, which direction should our policies go?
Improving the overall medical service system, rather than just blaming pregnant women would be the most effective way to cut the number of C-sections.
The DOH study once again found that "previous cesarean" is the main reason for the high C-section rate. Media reports have noted a widespread misconception that one Cesarean delivery would necessitate C-sections in future pregnancies and therefore, women do not try natural childbirth for subsequent births. But are there doctors who share this misperception? According to research findings, only a handful of doctors in this country are willing to perform "vaginal birth after Cesarean sections," or VBAC. The DOH survey showed that Taiwan's VBAC rate is less than than 5 percent.
As more studies are done on the behavior of pregnant women, shouldn't we also try to understand doctors' approaches and the difficulties they face in practicing VBAC? At the same time, can medical circles study VBAC and improve its technologies?
The survey also showed that Taiwan has a high percentage of women with an abnormal fetal position or breech presentation -- three or four times higher than that of Western countries. News reports quoted researchers as saying "breech presentation" might be used by doctors to apply for national health insurance payments. Can the Taiwan Association of Obstetrics and Gynecology probe such false declarations by doctors?
As for other reasons cited for C-section, such as women's fear of labor pains, has the medical system adopted measures to help women cope with labor pains? Is the handling of labor pains the focus of obstetric departments?
What about the "superstition theory" that has been cited for over a decade? There have been headlines reading, "Seventy percent of pregnant women choose [auspicious] timing." But looking at the questionnaire used in the recent survey, it turns out the original question was: "Do you think it is common for Taiwan's newborns to be delivered at a time chosen [by parents]?" Seventy percent of the respondents replied "common" or "very common" to the question. This is society's perception of pregnant women, not the reason why they "choose" C-sections.
A 1995 public-health study was interpreted as meaning half of C-sections were performed for the sake of auspicious timing. This became one of the main reasons cited to explain the high C-section rate. However, the women interviewed 10 years ago cited medical reasons for wanting a C-section, and "auspicious timing" was merely an "added value" after doctors had confirmed the need for a C-section. It was not the key reason for the operation, although a handful of healthy women did decide to have the operation for reasons of timing.
If all the studies over the years are correctly interpreted, they would show that the timing is definitely not a major reason. Why does the public still blame superstition as the reason for Cesareans? More must be done to reform the medical system and eliminate the misconception that superstitious pregnant women are demanding Cesareans.
Wu Chia-ling is an associate professor of sociology at National Taiwan University. Liu Chung-tung is a professor of medical sociology at National Defense Medical Center.
Translated by Jackie Lin
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