Caesarean section rates are significantly higher in Egypt than other parts of the world, with some doctors accused of deliberately steering expectant mothers to choose this for their own convenience – and as a way of making money.
“The doctor chose C-section not to interrupt his annual leave,” Mai Shami told the BBC, referring to the experience of a mother from her group. The doctor to whom she was referring allegedly decided to deliver the baby at a time which worked for him, rather than let it happen naturally.
A Caesarean section is when a baby is delivered by making a surgical cut in the abdomen and womb. They fall into three categories:
- elective – at the mother’s request and sometimes for non-medical reasons
- planned – usually for medical reasons, such as the baby is either in the wrong position or very large
- emergency – usually because of complications during labour
A year ago, Mai launched a Facebook initiative called Stop Medically Unjustified Caesarean Section, which is followed by more than 12,000 people around the Arab world.
The initiative was a fruit of her personal experience of giving birth two years ago.
“Doctors were pushing me towards Caesarean section as if it were the only, best and most appropriate way to give birth,” she said.
“During pregnancy, I visited more than one doctor and most of the time they pushed me towards Caesarean section for reasons, some of which are male-motivated, as they said a normal delivery may affect a woman’s sexual relationship after birth.”
Although evidence for this claim is inconsistent, obstetricians and gynaecologists who the BBC spoke to said this claim is often used by doctors to encourage more women to opt for a C-section.
One doctor that Mai visited gave a different reason for C-section, telling her it was “quicker, easier and less painful than a normal delivery”.
Some doctors were making money by encouraging women to have C-section as the procedure was more expensive than natural birth, Dr Randa Fakhreddin, a consultant obstetrician and gynaecologist in Cairo, told the BBC.
Doctors can also perform more than one C-section in a day, whereas natural births can potentially take hours.
According to the Egyptian Society of Gynaecology and Obstetrics, privately-owned hospitals where C-sections are carried out make more profit from them than natural deliveries, as the fees are much higher.
This could explain why C-sections account for 80% of births in these hospitals, while C-sections account for only 40% of all births in state-owned hospitals.
Mai insisted on giving birth naturally after spending a lot of time reading about the advantages and disadvantages of both methods of birth, and making sure she did not need a C-section for any medical reasons.
This choice was supported by the doctor who treated her in the final stages of delivery.
What is a Caesarean birth?
Caesarean sections: Why and when are they used?
Encouraging women to opt for a C-section without medical necessity is common in many countries around the world.
The World Health Organization (WHO) advises that a maximum of 15% of births should be via Caesarean section, but most countries exceed this limit. C-sections around the world have tripled in three decades, with one in five children born through it.
The Egyptian ministry of health says 72% of Egyptian women had C-sections in 2021. It has taken steps to reduce the number of unnecessary C-sections, like bringing fees into line with those for natural births; giving financial incentives to medics to encourage more natural births; and monitoring methods used by hospitals.
Mai says it is the weakness of the health system in monitoring hospitals and doctors which has been the main problem.
‘The doctor didn’t tell’
Mai Shami says lack of information can lead women to make decisions without insufficient knowledge – something her initiative aims to change.
Salma, a 32-year old mother, backs her campaign. She underwent a C-section months ago and says her doctor did not explain the alternatives.
“He didn’t talk to me about the options I had. He just talked to me about Caesarean section and asked when did I want to give birth,” she said.
“He also did not tell me about the complications that might occur after C-section and how I can deal with them.”
Salma said that if she had known all the details about giving birth naturally, she could have assessed the situation better.
Mai says women are also part of the problem, as they encourage each other to undergo C-sections either for the lack of information or because they are afraid of natural birth, not helped by social media, soap operas, and some doctors themselves.
Dr Fakhreddin meanwhile said the health system in the country made doctors frightened of taking risks, which meant they chose C-sections as a procedurally safer choice. If doctors make mistakes, they could be sent to court, which could spell the end of their careers.