Caesarean section rates in Egypt are significantly higher than in other countries. There have been accusations that doctors deliberately steered expectant mothers to choose this procedure for their own convenience, and to make money.

Mai Shami, referring specifically to the experience of a mother who was part of her group, said that “the doctor chose C-section to not interrupt his annual leave.” She claimed that the doctor she was referring chose to have the baby at a time that worked best for him instead of letting it happen naturally.

Caesarean section refers to the procedure by which a baby is delivered via a cut made in the abdomen and womb. There are three main types.

  • elective – at mother’s request or sometimes for non-medical reasons
  • Planned – usually because the baby is very large or in an incorrect position.
  • Emergencies – most often due to complications during labour

Mai created a Facebook initiative called Stop Medically Injustified Caesarean Section a year ago. More than 12,000 people follow Mai’s Facebook page.

This initiative was born out of her own personal experience with giving birth two years back.

“Doctors were pushing us towards Caesarean Section as if that were the only, best, and most appropriate way to have a baby,” she stated.

“During pregnancy, my visits to multiple doctors were overwhelming and they encouraged me towards Caesarean section. Some of these reasons are male-motivated as they suggested that a normal birth could have an impact on a woman’s sexual relationships after giving birth.

Although there is insufficient evidence to support this claim, the BBC spoke to obstetricians as well as gynaecologists to confirm that doctors use this claim often to encourage women to choose a C section.

Mai saw a different doctor who explained to her that C-section was faster, easier, and less painful then a normal delivery.

Image source, Mai Shami
Image caption, A warning on Mai’s Facebook group page: Protect your child and yourself from unnecessary C section

Dr Randa Fakreddin, a Cairo-based consultant obstetrician/gynaecologist, said that some doctors made more money encouraging women to have C section because the procedure was more costly than natural birth.

It is possible for doctors to perform multiple C-sections within a single day. Natural births may take several hours.

According to the Egyptian Society of Gynacology and Obstetrics C-sections can make more money for private hospitals than natural deliveries. This is because of the higher fees.

This could be why C-sections account in these hospitals for 80% of births while only 40% of state-owned hospitals have C-sections.

Mai wanted to give birth naturally, even though she had spent a lot time researching the pros and cons of each method of birth and making sure that she didn’t need C-sections for any medical reasons.

This decision was supported by the doctor who cared for her in the final stages after delivery.

Media caption,Caesarean sections – Why and when do they get used?

In many countries, it is not uncommon for women to choose a C section without medical necessity.

The World Health Organization advises that no more than 15% of births should occur via Caesarean Section, however most countries go beyond this limit. In the last three decades, C-sections have tripled around the world. Today, one in five children are born via them.

According to the Egyptian ministry, 72% Egyptian women were subject to C-sections in 2021. It has taken steps in order to decrease unnecessary C-sections. These include raising fees to be comparable to natural births, giving financial incentives to doctors to encourage natural births, and monitoring hospital procedures.

Mai claims it’s the failure of the health care system to monitor hospitals and doctors that has been the biggest problem.

Mai Shami argues that insufficient information can cause women to make bad decisions. This is what her initiative aims at changing.

Salma, a 32 years old mother, supports her campaign. She was forced to have a C section months ago by her doctor.

“He didn’t discuss the options that I had. He talked to my about Caesarean section, and then asked me when I would like to give birth,” she replied.

Image source, Salma
Image caption, Salma gave Birth by C-section Without Knowing the Options

“He did not inform me about possible complications after C-section or how I could deal with them.”

Salma claimed that if Salma had all the information about giving birth naturally, she might have made a better assessment of the situation.

Mai also believes that women are part of the problem. Mai said they encourage each other in C-sections due to lack of information, or because they fear natural birth. Mai isn’t helped by soap operas or doctors.

Dr Fakhreddin stated that doctors are afraid of taking risks due to the country’s healthcare system. This led them to choose C-sections because they were safer. If doctors make mistakes, they can be sent to court which could mean the end of their career.

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