UAE doctors highlight cultural and healthcare divide over C-section births

Doctors point to nationality of parents-to-be and choice of healthcare provider as key factors

Doctors have painted “a mixed picture” over attitudes to Caesarean section procedures in the UAE, claiming nationality and use of public or private health care influence decision-making.

C-section rates have trebled across the globe, from 7 per cent of all births in 1990 to 21 per cent last year, a World Health Organisation study found. It estimates that nearly a third of births will be by C-section by 2030.

Health experts in the UAE indicated that expectant Emiratis largely prefer natural birth, with more expat mothers-to-be electing for C-sections.

C-sections are when a baby is delivered through incisions in the mother’s abdomen and uterus.

They are often essential, such is in cases of prolonged or obstructed labour or foetal distress, but concerns have been raised over numbers of women electing for this surgery to avoid the pain of labour or for lifestyle reasons.

“I came from Abu Dhabi where most locals want normal deliveries,” said Dr Surekha Pai, a specialist in obstetrics and gynaecology at NMC Royal Hospital in Dubai.

“They plan to have more than one child and know that it is the first delivery that determines all future deliveries.

“The expats want C-sections primarily because they plan to have one or two deliveries and don't want to endure the pain and wait for a long time in labour.”

She said mothers-to-be are educated by staff about the benefits of a natural birth and urged to avoid major surgery unless it is justified for health reasons.

Concerns over global rise

The WHO says a C-section rate of 10 to 15 per cent is optimal, with higher figures placing a burden on resources and exposing patients to increased health risks.

A 2019 study by the global health body covering 22 nations in the Eastern Mediterranean region placed UAE C-section rates at 24 per cent — slightly above the worldwide average.

Iran and Lebanon had rates of 48 and 46 per cent, respectively, while new figures released by health authorities in Egypt showed C-sections accounted for 72 per cent of all births last year.

Dr Amber Syed, a consultant obstetrician and gynaecologist at HealthBay Polyclinic in Dubai, said doctors would not generally encourage patients to undergo a C-section instead of natural birth, unless it was in the patient's best interests.

But she said approaches differ between the public and private sector.

“C-sections are typically more expensive than a normal birth … and normal birth can happen anytime out of hours,” she said.

“If you do a C-section, you can plan it, you can do it in the morning, and then you're done.

“So, there is definitely that drive but that would be the same for any private healthcare setup. So, not just the UAE but anywhere in the world.

“Having said that, there are huge variations in practice. At my own practice, I'm very pro natural, and my rates are less than 10 per cent … but there are doctors who have a 50 to 60 per cent rates.

“You will find that there is a difference in rates between the government hospitals and the private hospitals because the government hospitals are not driven by profit.”

Health insurance will only cover a C-section if there is a report from a doctor stating that it is a medical necessity.

One in 3 births by C-section at Abu Dhabi hospital

At Corniche Hospital in Abu Dhabi, which is run by Seha — the company responsible for managing government-owned healthcare facilities in the emirate — about 300,000 babies have been delivered since 1977.

C-sections currently account for about a third of births there.

Dr Paul Bosio, chief executive and chief medical officer of the facility is comfortable with this figure, due to its status as a hospital delivering specialist care in the field.

“When you look at C-section rates, you need to take into account the population of patients that the provider looks after,” he said.

“We have a disproportionate number of complicated pregnancies that are referred to us because they're high risk. Our rate is influenced by the fact that we're a tertiary maternity hospital, which does complicated pregnancies more than anybody else.

“So, that rate for me as a tertiary hospital I'm comfortable with. If I were a provider just looking after normal pregnancies and not a lot of complications, then I would want to have a lower rate.

“I think it's a mixed picture on overall C-section rates. I would probably say we are on the middle to high side but not that high.

“If you look at worldwide WHO reported figures, then the range of C-section rates across the world varies a lot between countries.

“The overall rate in the UAE, and Abu Dhabi in particular, is generally average when compared against most developed countries but even here there exists a wide range between different hospitals.”