PETALING JAYA: A Caesarean section, or C-section, has become common these days although normal deliveries were still preferred.
A C-section is an operation to deliver a baby through a cut made in the mother’s abdomen and womb. The cut is usually made just below the navel, with the entire procedure lasting about 45 minutes.
Health Director-General Tan Sri Dr Noor Hisham Abdullah confirmed that there was an increase in the number of C-sections performed worldwide. He said the percentage of C-sections in Organisation for Economic Co-operation and Development (OEDC) countries stood at 28%, while it was 27.6%
“Around the globe, C-section procedures have increased. The growing rate can be attributed to factors such as births among older women, multiple births through assisted reproduction, technological advances and personal preference.
“However, they involve a degree of risk and can cause possible complications in subsequent deliveries,” he said.
Malaysian Medical Association president Dr Koh Kar Chai said C-sections in Malaysia have increased by 3% over the last five years.
Koh, who quoted a study on 11 tertiary state hospitals and one federal territory hospital from 2011 to 2015, said 141,257 (23.2%) of 608,747 deliveries involved C-sections.
On whether women could be coerced to undergo a C-section, he said it was almost impossible to influence them since they have the right to seek a second opinion from doctors, who are obligated to explain its risks and benefits.
Koh added that women and their families also need to understand the consequences of consenting to a C-section.
“It is legally and ethically required for doctors to ensure they fully understand the risks and benefits of the procedure and consent to it as well as discuss alternative management.
“In most situations, especially during emergencies, clarification, discussion and consent are usually with the woman and her partner, if present. Other family members may seek further clarification if required.”
Koh said doctors would consider certain health conditions, such as diabetes and foetus size, before recommending a C-section.
Prince Court Obstetrics and Gynaecology physician Dr Tan Niap Hong said it was professionally unethical and illegal to persuade mothers to undergo a C-section.
He said women are advised to have the procedure only if their health condition increases the risk of complications in a normal delivery.
“Of course, it will be unethical to perform a C-section without proper indications and informed consent.
“In the absence of a clear indication, it is impossible to obtain informed consent and maintain proper medical records of the management of the pregnancy.
“Doctors need to explain the procedure and document it in the medical record as this is part and parcel of informed consent.”
The cost of a C-section is not fixed as it depends on the usage of equipment and room preferences, with charges at government hospitals based on three room categories.
Excluding treatment fees, C-sections at a third class ward would cost RM100 for surgical fees, RM400 in second class wards and RM1,200 in first class.
Some private hospitals charge as much as RM12,000 for surgical fees.