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‘Unnecessary’ and risky caesarean births in Kenya

By Gatonye Gathura | August 3rd 2020 at 12:00:00 GMT +0300

Ann Kamore of Ndumberi in Kiambu, is facing a crisis over where to deliver her second baby in less than a month.

“I am a meticulous planner and do not like surprises,” says Kamore an employee of a Mombasa-based tour firm.

She had planned the delivery to fall on the third week of August, with all details for the caesarean birth including payments, recuperation and even date of return to office worked out.

“Caesarean was the only option for me because I can’t bear to push, I can control things and also I have a good insurance cover.”

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Kamore says all along she thought everything had fallen into place until last week when the hospital called to say charges had been adjusted upwards.

This, she was told was due to some Covid-19 protocols, with her insurance not willing to pick up the extra tab.

“I am told to add about Sh100,000 over the initial cost, something I was not prepared for,” Kamore said in a phone interview.

“Surgery has become more expensive especially because of the extra gear required to protect against Covid 19. In fact, we have cancelled all elective surgeries including caesareans for safety concerns,” says Evelyn Mbue, a critical care nurse at a medium level private facility in Nairobi.

Recently, the Cabinet Secretary for Health, Mutahi Kagwe said deliveries have become very expensive with a single event taking up to 15 sets of personal protective equipment.

Kamore now says she is desperately shopping for a cheaper facility where she can still do caesarean within her insurance cover; but few are taking on elective procedures.

Asked how the women and families are taking the cancellations, Mbue said they have a problem especially with working women.

“House wives are actually calling in to change to normal delivery but two professional women have threatened to report us to the regulatory board,” said Mbue though not overly worried. The Health ministry had earlier cancelled all elective surgical procedures.

In the last decade the number of caesarean births in Kenya hit an all-time 14.9 per cent high; well above the 10 per cent recommended as rational by the World Health Organisation.

10 per cent is considered ideal for a country like Kenya otherwise above that it is considered overuse and a possible strain to health resources.

“Professional women are largely responsible for the spike in caesarean births,” says a new study at the Moi Teaching and Referral Hospital, Eldoret (MTRH).

The study had interrogated the records of 12,209 births at the public maternity wing of the hospital for a one year period.

Majority of the women, 58 per cent were housewives with 11 per cent having a professional occupation such as employ in government or private company.

The C-section rate from all the women was 16.5 per cent, varying from 21 per cent among professionals to 16 per cent among housewives, and 14 per cent among students.

An epidemic

Women like Kamore who had had their first birth through C-section were likely to have following deliveries through the same methods even without any medical reason.

“Our findings suggest that unnecessary primary C-sections, combined with a practice of near universal repeat caesareans are fueling an epidemic,” says the study published last month (July 2020) in the International Journal for Equity in Health.

Unnecessary C-sections, the doctors caution, may cause needless mother and child deaths with a one per cent possible uterus rapture in repeat surgeries.

A recent assessment of health facilities providing caesarean section deliveries in the country found 18 per cent did not have a surgical care provider.

The MTRH study also found the hospital to sometimes wrongly prescribe C-sections even when there is no good medical reason to do so.

Data at the national level shows the richest women, the highly educated, the insured, managers, urban residents and those who delivered in mission or private facilities   are twice likely than poor women to go for elective cesarean delivery.

To reduce the epidemic, the doctors suggest hospitals adopt better pain relief and labour support practices while educating women on the risk especially in repeat C-sections.

Ban of elective C-sections?

Furthermore, they advise investments in training, and equipment for assisted vaginal birth, especially vacuum extraction, can reduce C-section rates.

“Prevention of unnecessary primary C-sections and promoting safe trial of labor with close monitoring in women with a scarred uterus should be a priority in addressing over-use of C-section.”

Doctors have suggested the Ministry of Health ban elective caesarean. “Medical indication and maternal informed choice should be the only basis for caesarean delivery,” says Malachi Ochieng Arunda of Lund University, Sweden

Arunda, who with colleagues had in April analysed the status of caesarean deliveries in Kenya and Tanzania says financial gains by hospitals should not form the basis for advising women to go under  the knife.

But whatever the direction C-section deliveries take in the country, Covid 19 may have a lasting impact.


Covid-19 caesarean birth
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