rani
Administrator
Four in 10 HK babies born under the knife
Alarm expressed at rise in Caesarean sections
From the SCMP 22/3/10
Four out of 10 women who give birth in Hong Kong now have Caesarean sections - a rate that is double the average for the developed world.
In private hospitals, six out of 10 babies are born under the knife.
Doctors warn of grave dangers behind the figures. Caesareans carried out for non-medical reasons are linked to a much higher risk of maternal death and serious complications, according to the latest survey by the World Health Organisation in Asia.
Hong Kong's Caesarean rate has been on the rise in recent years, creeping up from 36 per cent in 2006 to 41.6 per cent in 2008. A WHO study in 2007 showed that the rate in developed countries was only 21.1 per cent.
The trend is causing particular alarm in private hospitals, where mothers can freely choose the way they give birth. In 2006, 59 per cent of 25,141 women in private care had Caesareans. This had jumped to 62 per cent in the first half of last year.
At least a quarter of pregnant women requested the operation for reasons other than medical ones, such as fung shui or fear of pain, one local doctor said.
The average Caesarean rate across Asia is 27.3 per cent - 19.8 per cent in Japan, 35.6 per cent in Vietnam and 46.2 per cent on the mainland. The percentages for Latin America and the United States are 35 and 31 per cent respectively.
The WHO survey revealed that the risk of maternal death or severe complications increased up to 14.2 times when Caesarean sections were done without a medical reason.
The risk of wounds being infected is much higher, as is the possibility of severe blood loss that would require a blood transfusion.
The study, which was published in the March 6 issue of the medical journal The Lancet, looked at 107,950 deliveries across nine countries in Asia, excluding Hong Kong.
Unnecessary Caesarean sections had been associated with increased risks in previous studies, such as a WHO survey in Latin America. Women who had undergone a number of Caesarean sections were more likely to have problems with later pregnancies, such as stillbirths, uterine rupture and premature births.
A spokesman for the Hong Kong College of Obstetricians and Gynaecologists, Dr Robert Law Chi-lim, said the increasing rate of Caesarean sections was a trend across the world. "More borderline cases will now go under the knife," he said.
Private obstetrician Kun Ka-yan said there were a number of reasons behind the high Caesarean rate. Mothers were less tolerant of pain than in the past, and Caesareans had become safer so more mothers were recommended to take it, he said.
Another factor is weight. In the past when handling large babies, doctors would only perform a Caesarean if it weighed more than 4kg. They are now often performed if it weighs 3.7kg. The same applies to breech births, in which the buttocks or feet are delivered first. In the past such these were delivered naturally.
"Fewer babies are born these days. Whenever we have a minor doubt, we tend to play safe and do a Caesarean," Kun said.
Kun said another reason was that more mainland mothers now give birth in Hong Kong. "They only get a permit here and cannot stay in Hong Kong forever. Many of them would like to complete the whole process of giving birth and getting identity documents within one week. Caesareans are more predictable."
But 70 to 80 per cent of elective Caesarean births were due to fung shui, the doctor said. Kun said that while he would explain to his patients the risks of going under the knife, it was ultimately the mother's choice. "Even if I refuse to do a Caesarean, another doctor will do it."
Fung shui master James Lee Shing-chak said he was approached by more than 100 mothers a month for advice on the best day to deliver their babies.
"Some of them want their babies to be born with an emperor's fate, some of them just want to avoid the unlucky days," he said.
Mothers tended to avoid festivals associated with deaths.
But Lee said the choice was sometimes limited as doctors might not be willing to deliver the baby at the time chosen. "Some do not want to wake up too early or work too late, and some do not want to do it on Sundays," he said, adding that some mothers would change their doctors as a result of this.
Lee reminded mothers that it was against "heaven's will" to choose their babies' birthday. "These babies will have a lower emotional quotient because their mothers did not bear the pain in a natural delivery."
One mother who is opting for a Caesarean section is due to give birth at St Teresa's Hospital in Kowloon City early next month. She has chosen April 4, Children's Day, to be her baby's birthday.
"I mainly do not want to go through the pain [of vaginal delivery]," she said, adding that she was not aware that a Caesarean might be riskier.
Alarm expressed at rise in Caesarean sections
From the SCMP 22/3/10
Four out of 10 women who give birth in Hong Kong now have Caesarean sections - a rate that is double the average for the developed world.
In private hospitals, six out of 10 babies are born under the knife.
Doctors warn of grave dangers behind the figures. Caesareans carried out for non-medical reasons are linked to a much higher risk of maternal death and serious complications, according to the latest survey by the World Health Organisation in Asia.
Hong Kong's Caesarean rate has been on the rise in recent years, creeping up from 36 per cent in 2006 to 41.6 per cent in 2008. A WHO study in 2007 showed that the rate in developed countries was only 21.1 per cent.
The trend is causing particular alarm in private hospitals, where mothers can freely choose the way they give birth. In 2006, 59 per cent of 25,141 women in private care had Caesareans. This had jumped to 62 per cent in the first half of last year.
At least a quarter of pregnant women requested the operation for reasons other than medical ones, such as fung shui or fear of pain, one local doctor said.
The average Caesarean rate across Asia is 27.3 per cent - 19.8 per cent in Japan, 35.6 per cent in Vietnam and 46.2 per cent on the mainland. The percentages for Latin America and the United States are 35 and 31 per cent respectively.
The WHO survey revealed that the risk of maternal death or severe complications increased up to 14.2 times when Caesarean sections were done without a medical reason.
The risk of wounds being infected is much higher, as is the possibility of severe blood loss that would require a blood transfusion.
The study, which was published in the March 6 issue of the medical journal The Lancet, looked at 107,950 deliveries across nine countries in Asia, excluding Hong Kong.
Unnecessary Caesarean sections had been associated with increased risks in previous studies, such as a WHO survey in Latin America. Women who had undergone a number of Caesarean sections were more likely to have problems with later pregnancies, such as stillbirths, uterine rupture and premature births.
A spokesman for the Hong Kong College of Obstetricians and Gynaecologists, Dr Robert Law Chi-lim, said the increasing rate of Caesarean sections was a trend across the world. "More borderline cases will now go under the knife," he said.
Private obstetrician Kun Ka-yan said there were a number of reasons behind the high Caesarean rate. Mothers were less tolerant of pain than in the past, and Caesareans had become safer so more mothers were recommended to take it, he said.
Another factor is weight. In the past when handling large babies, doctors would only perform a Caesarean if it weighed more than 4kg. They are now often performed if it weighs 3.7kg. The same applies to breech births, in which the buttocks or feet are delivered first. In the past such these were delivered naturally.
"Fewer babies are born these days. Whenever we have a minor doubt, we tend to play safe and do a Caesarean," Kun said.
Kun said another reason was that more mainland mothers now give birth in Hong Kong. "They only get a permit here and cannot stay in Hong Kong forever. Many of them would like to complete the whole process of giving birth and getting identity documents within one week. Caesareans are more predictable."
But 70 to 80 per cent of elective Caesarean births were due to fung shui, the doctor said. Kun said that while he would explain to his patients the risks of going under the knife, it was ultimately the mother's choice. "Even if I refuse to do a Caesarean, another doctor will do it."
Fung shui master James Lee Shing-chak said he was approached by more than 100 mothers a month for advice on the best day to deliver their babies.
"Some of them want their babies to be born with an emperor's fate, some of them just want to avoid the unlucky days," he said.
Mothers tended to avoid festivals associated with deaths.
But Lee said the choice was sometimes limited as doctors might not be willing to deliver the baby at the time chosen. "Some do not want to wake up too early or work too late, and some do not want to do it on Sundays," he said, adding that some mothers would change their doctors as a result of this.
Lee reminded mothers that it was against "heaven's will" to choose their babies' birthday. "These babies will have a lower emotional quotient because their mothers did not bear the pain in a natural delivery."
One mother who is opting for a Caesarean section is due to give birth at St Teresa's Hospital in Kowloon City early next month. She has chosen April 4, Children's Day, to be her baby's birthday.
"I mainly do not want to go through the pain [of vaginal delivery]," she said, adding that she was not aware that a Caesarean might be riskier.
