KARACHI, July 21: The reason why gynaecologists are increasingly preferring Caesarean section operations to normal delivery is that they are costlier and more convenient to doctors.

A Caesarean section is an operation in which a doctor cuts through the abdomen and the uterus, referred to as the womb in common parlance, and takes out the baby. It is named after Julius Caesar, who was supposedly born this way.

Doctors point out that gynaecologists should refrain from opting for a Caesarean section unless a patient expressly asks for it and unless it is inevitable, such as in cases where the patient has high blood pressure or there is fetal distress or the cervix — the neck of the womb — has not enlarged enough.

They say the reason why caution should be exercised is that the mortality rate in Caesarean section operations is five times higher than in normal vaginal delivery. They point out that as it is the maternal mortality rate is very high in the country.

The latest report of the Human Rights Commission of Pakistan, titled “State of Human Rights in 2001,” says: “The maternal mortality rate is estimated at 500 for every 100,000 live births, again one the of the highest in the world, while the infant mortality rate, at 91 per every 1,000 live births, is the highest in the region by a wide margin.”

The secretary-general of the Pakistan Medical Association, Dr Shershah Syed, admits that a large number of gynaecologists opt for a Caesarean section merely for monetary considerations.

“The internationally recognized figures for Caesarean sections are 15 per 100 operations. While no government agency has compiled figures for Caesarean sections in Pakistan, it is believed to be quite high.”

Dr Syed says proponents of Caesarean sections cite the figures of the United States where Caesarean sections are around 30 per cent. “In this regard, two things should be kept in mind. First, in the US the charges for a Caesarean section and normal vaginal delivery are same. So there is no monetary incentive. Second, the records of a child’s birth are maintained for at least 21 years in America which means that if a complication arises in the future a doctor can be taken to court or held responsible. Such high standards of medical ethics are not followed in Pakistan.”

Dr Nighat Shah, gynaecologist at Murshid Hospital, stresses that those women who need a Caesarean section should get it. “At least 80 per cent of births in the country take place at home either with the help of unskilled midwives or because patients fail to reach hospital in time.”

She says Caesarean sections are the commonest operations which are carried out in private medical hospitals. “Patients repose infinite trust in a doctor. When a gynaecologist advises them to opt for a Caesarean section saying that normal vaginal delivery could pose a danger to the patient’s life, she takes his/her word for it.”

However, Dr Syed insists that government medical hospitals should not be criticized for performing more Caesarean sections. “A lot of complicated cases come to government hospitals. Sometimes, they receive cases which are exacerbated by midwives. At other times, people come from farflung areas with complicated cases. Then government hospitals have no option but to go for Caesarean sections.”