In a December 2nd article on Today's Zaman website, reporter Ayse Karabat writes about a shocking policy on cesarean delivery in Turkey, and one that disturbingly echoes some of the calls for cesarean delivery restriction in countries like the UK, U.S. and Australia.
The report says that Turkey's Ministry of Health wants to reduce its cesarean rate from 42.5% to 25% by restricting cesarean deliveries only to those who medically need them.
In a statement issued this year, it declared that from Sept. 1, the number of cesareans at a health institution "will be taken into consideration when calculating the performance of hospitals. Pursuant to this statement, [cesareans] should be no more that 20% of all births in research and training hospitals and no more than 15% for other hospitals. If the [cesareans] in a hospital are higher than these levels, hospital funding and staff pay will be cut."
You may remember our press release back in October 2008, when the Coalition for Childbirth Autonomy warned of the dangers of forcibly or artificially reducing a nation's cesarean rate to the outdated level recommended by WHO in 1985. Well, perhaps the shocking practices now taking place in Turkey might be a lesson to other government health strategists:
UNETHICAL, FALSE ECONOMY and ultimately UNSUCCESSFUL approach
Comments by doctors working in the obstetric field highlight many of the points I have made in the past about the repercussions of reducing cesarean deliveries simply in order to achieve a 'magic number' - rather than making the best decision in each individual case.
Avoidable mortality and morbidity with PVD costs more than CS
*The news report states that "since the implementation of this program, doctors have been discussing the subject. Some are claiming that the money which is being spent to deal with complications resulting from normal births is higher than the expenditure" for cesarean deliveries.
Critical health care decisions belong in the room the birth takes place
*"Doctors are critical of the program from the Ministry of Health, claiming that decisions regarding [cesareans] can be taken only by doctors and to question it is unethical."
Litigation pressure and costs should not be ignored or underestimated
*"Professor Turgay Şener, the chairman of the Turkish Perinatology Association, has said any directions from the Ministry of Health will not be useful in reducing the amount of [cesareans]. "Restrictions can lead to disagreements between doctors and patients. If there is even a small problem, the patient will ask the question if it was because of the normal birth."
Enhanced health outcomes are missed when a valid delivery route is avoided
*"The doctors will feel pressured and will choose normal births in some cases where cesarean sections are better," [Professor Şener] underlined.
Financial reward (or fear of financial loss) influences doctors' decisions
*"Turkish Gynecology and Obstetric Association Chairman Bülent Tıraş has suggested that the number of [cesareans] will affect the performance of the whole of the hospital and have an impact on other doctors' pay, so this may put pressure on gynecologists to choose normal births."
Does all this really help women and their babies?
No, of course not. It's interesting to read though, that Turkey's strategy uses the slogan: "Every pregnant woman should be given the chance to give birth naturally." I think it would make a lot more sense, save a lot more lives, and avoid a lot more birth injuries if Turkey altered its slogan to this one:
"Every pregnant woman should be given the chance to give birth in the way she chooses to."
And if the woman doesn't have a particular choice one way or the other (some don't), then it should be a case of providing the best possible health care on the day of the birth, regardless of how that birth outcome might affect a table of statistics on a desk somewhere in the hospital.