I am a midwife, childbirth educator, lecturer, doula, and natural mother of eight children. This is not a medical reference; I do not proclaim to give medical advice. Anything stated here is from personal experience, research, study, and opinion. Each woman has the responsibility to do her own research, consult with her own medical team, and make her own decisions about pregnancy and birth.

Saturday, November 27, 2010

Saudi Cesarean Sections

Bismillah al-Rahman al-Rahim
I've been blogging for a couple of months now, but not much of what I've written has been based on Saudi Arabia.  Since the blog title is "Saudi" Birth Story I figured I'd better find out a little more about the birth statistics in Saudi Arabia.

What I found during my research astounded me.  What I concluded, however, gives me hope.  Now if I can only make my voice heard far enough to make a difference.  Please pass this on to others you know.  With Allah's help it may just reach the people who have the power to effect change!

I hope you enjoy reading this article.  Please let me know if you have a story idea or would like to share your birth story. Now on to the article...Saudi Cesarean Sections...

My research for birth statistics in Saudi Arabia led me to a report with some alarming data.  (Ba'aqeel HS. Cesarean delivery rates in Saudi Arabia: A ten­ year review. Ann Saudi Med 2009;29:179-83) 

Some of the quotes from that report include:
  •  "Cesarean delivery (CD) is one of the most commonly performed surgical procedures in Saudi Arabia."
  • "A significant increase of more than 80% in the CD [cesarean delivery] rate was observed from 1997 to 2006."
  • "A national strategy to reduce the CD [cesarean delivery] rate is needed..."  (Remember this comment.)
Whoa!  The cesarean rate has increased by 80% in just ten years?!?  That's a terrifying epidemic from my perspective!

Delving deeper I found that the cesarean delivery rate in 2006 was at 19.1%.  Although this is lower than the American average, it is still above the commonly known recommendation by the World Health Organization that caesarean deliveries should not exceed 10–15%.

Anytime I discuss cesarean deliveries I must first give credit to the procedure and the skilled doctors who perform them when there is a health or life threat to the mother or baby.  But I also have to wonder how many of those surgeries were really necessary?

I feel compelled to list some of the increased risks associated with the cesarean delivery:

  • longer, more expensive hospital stays
  • minor or major allergic reaction to anesthetic (mother or baby)
  • increased infections
  • blood clots
  • need for blood transfusion
  • resulting hysterectomy (surgical removal of the uterus)
  • damage to the bladder or other internal organs
  • more likelihood of prematurity of the infant (cesareans done based on faulty due dates)
  • infant respiratory problems
  • higher rate of maternal or neonatal death
There are many more risks than I've listed here.  One such additional risk is the increased need for cesarean delivery in future pregnancies and the associated risks of uterine rupture that comes with repeat pregnancy after cesarean delivery.  This is especially noteworthy in Saudi Arabia where women are more prone to having large families.  (According to a report of published figures, the Saudi average birth rate is 5.8 children.)

I read a commentary in the October issue of Ob/Gyn News titled:  The Cesarean Section:  A View From the Trenches, written by Dr. David M. Priver, M.D.  This article had some interesting things to say about why the cesarean rates have increased, from the practitioner's perspective.  I have paraphrased his theories for you here:

  • Increased litigation against doctors has caused them to err on the side of caution by taking control of the birth surgically, rather than letting nature take its course
  • Impatience on the part of the doctor or mother prior to the onset of labor (resulting in induced labor which increases risk of cesarean, or elective cesarean from the start)
  • Impatience on the part of the doctor or mother during labor (resulting in the attempt to speed labor with drugs which also increases risk of cesarean, or elective cesarean after a short trial of labor)
  • Repeat cesareans without first attempting a vaginal birth after a cesarean was performed for a prior birth (by doctor or mother's choice)
  • Automatic cesarean for breech babies (the skill of delivering breech babies vaginally is becoming a lost "art')
This mirrored my experience in discussing cesarean rates with obstetricians I know personally.  One such obstetrician told me that the "art" of obstetrics is being lost to the "knife."  

In the article Why Are Nearly a Third of Childbirths Cesareans?, an article from my new favorite blogging doctor, Dr. Mercola, says the following:

  • "...this massive increase in the CS [cesarean section] rate has not improved obstetrical outcomes...mothers and newborns have not benefited from more CS [cesaean sections]..."
  • "Obstetricians are specially trained surgeons, taught from early on how to use surgical and other medical interventions to assist in childbirth. They certainly have their place in the medical field...helping high-risk women deliver babies...But this is the minority of women." 
  • "More than 75 percent of women have normal pregnancies, meaning all of the surgical interventions obstetricians are trained to use are [often] unnecessary."
  • "Unless there is a complication, medical interventions are typically unnecessary, and often do more harm than good."

When considering the reasons behind cesareans both Dr. Mercola and I suggest the Rikki Lake film The Business of Being Born.  In the trailer alone it states:
  • "Hospitals are businesses..."  inferring it's all about money
  • "...if you're gonna have good stuff you might as well use it..."  referring to high tech hospital equipment
  • "...people don't have the information..."  to make informed childbirth decisions (this is where the childbirth classes I teach comes in to play)
  • "...medical decision are being made for monetary and legal reasons, not because they are good for the mother and baby..." no additional comment needed
  • "How often do you get to see a fully natural birth?"  asked of a group of obstetric nurses
  •  "Almost never." the reply of those nurses
  • "C-section is extremely doctor friendly; it's 20 minutes and I'll be home for dinner" as stated by an obstetrician
That last statement rings so true of my personal experience working with an obstetrician.  May Allah reward her as she has learned from me about natural birth and begun to put it to use in her practice.  However, prior to our friendship, she was recommending ELECTIVE cesareans to her patients.  She felt it was a "mercy" to "spare" them the pain of labor and delivery.  She also admitted that it was easier for her as she didn't have to see her patient in pain.  (Think about that...it was easier for HER, the doctor, because she didn't have to see the patient's pain.  What about the long lasting pain AFTER the surgery?  What about the increased risks?  Who gets stuck with that?  Not HER, but the new mother!)

When I met her husband he asked me, "What have you done to my wife? All she talks about now is natural birth.  Before she used to do cesareans and be gone for 45 minutes for a delivery, and now she leaves the house for hours on end; plus she brings home less pay!"  What's sad is that this man is a doctor too!  Although not in obstetrics, thankfully.

This all brings us back to the earlier comment, "A national strategy to reduce the CD [cesarean delivery] rate is needed..."  (I told you to remember this comment.) 

In Dr. Priver's article, noted above, he says, "...we might wonder why obstetricians are paid...more – for doing a CS [cesarean section], which involves an expenditure of 30-45 minutes of time, as opposed to guiding a woman through a labor and vaginal delivery, which often requires infinitely more judgment and skill. Consider what would happen to the CS [cesarean section] rate if obstetricians were paid $800-$1,000 more to accomplish a vaginal delivery..."

Now there's an idea worth considering!  I'd be the first to line up doctors and teach them how to work with their patients to achieve completely non-medicated births, insha'Allah.  I'd be eager to train others to be teachers in order to reach the millions of women whose births this type of change could effect.  How about taking it a step further and providing a monetary reward to the mothers who acehive a totally natural birth?  Now that would be a happy ending to this story, don't you think?


  1. Asalam Alaikum, Jessi.

    Thanks so much for taking the time to read this and to comment. I added one last thought after you read it:

    "How about taking it a step further and providing a monetary reward to the mothers who acehive a totally natural birth?"

    I like that idea a lot!

    Best regards,

    -Aisha, Natural Mom

  2. Unbelievable that C-sections is the medical professional choice for deliveries. But of course, fast, easy money. There's no income/money to be made, with natural births. It will be an uphill battle to change the system. It's all about business/money...not about the patient...in this case, mothers-to-be.

    Great website - well done.

  3. Asalam Alaikum,

    Thanks to "Anonymous" for reading and commenting. Unfortunately, medically "managed" birth tends to be the preference over "natural" by many doctors and this is not unique to Saudi Arabia.

    One thing that I love about Saudi, however, is that if you can reach and convince the right person you can effect change. Individuals with power in this country have it within their hands to make a difference, as opposed to the government monstrosity and bureaucracy in the States where it takes much more lobbying and "process" for changes to ever be made.

    I have faith, that with the help of Allah, it is possible, insha'Allah.

    Best regards,

    -Aisha, Natural Mom

  4. Asalamu Alaikum,

    Masha'Allah great research and presentation Aisha! After reading this post, I am thanking Allah that I had a midwife who steered me away from a C-section.

  5. Salaam Alaikum,

    I had just read an article about C-sections in the US. The numbers are truly appalling. May Allah bless you in your efforts to educate doctors and pregnant women, Ameen!

  6. Wa alaikum asalam, ya Tara and Nancy,

    Thanks to both of you for reading and taking the time to comment.

    Tara, you are so blessed to have had a midwife, masha'Allah. Honestly, in the vast majority of births where things are "normal," a midwife is better equipped to handle things than a surgeon who is trained on "abnormality" (obstetrician).

    Well stated, Nancy, "appalling," I couldn't agree more. It truly is an "epidemic!"

    Best regaards to you both,

    -Aisha (Natural Mom)

  7. Assalamualikum

    An amazing article indeed. Whats truly amazing is you are an ideal women in yourself... Having 8 children mashAllah and todays woman is so steered up by the fear portrayed in the media that she thinks that she has made a leap 4 mankind when giving birth to only 2 or 3. MashAllah you have truly inspired me. Jazakallahu khairan, may Allah make ur endevour a success aameen.

  8. Wa alaikum asalam, ya Mahjabeen,

    Thank you for taking the time to read and to comment. I appreciate your feedback.

    Jazakallahukhyrn for your dua, ameen and I pray Allah makes me what you think of me and he is the best knower.

    Alhamdulelah for the technology that can save lives and at the same time I pray that Allah guide us all to that which is natural in birth and steer us away from inflicting harm upon our bodies by unnecessary medical interferences.

    Allah is in control of all things. In Him I place my trust.

    Best regards,

    -Aisha, Natural Mom

  9. Assalamualikum,
    I agree with you, from a natural midwife, who left the work in hospitals, i can not continue to work,we as a medical team forgot what it is gentle huminised birth, we are more technological birth


  10. Alsalamoalykom,
    You are natural Mom , but i am the natural midwife, we have common believes in natural birth, i do also Child birth classes in Arabic, English, in Holland.i am palastenian midwife
    i wil be happy if you like to write in my web site in English, i translate to arabic.

  11. Salam alaikum, Ukhti Izdihar,

    Thank you for reading and commenting. How sad that we are bullied by technology when trying to help women in the most primal, natural act of life!

    Do you mind telling me where you live? (Just which country).

    JZK for sharing your experience. I'd love to post a story from your perspective, if you'd care to write it, insha'Allah.

    Best regards,

    Aisha, Natural Mom

  12. Salam alaikum, Ukhti Tashkuraty,

    Masha'Allah, tabarak Allah! How fortunate for the Muslimah sisters in Holland to have you!

    I will visit your site, insha'allah. Please email me directly about your request so I can clarify your proposal. :)

    Best regards,

    -Aisha, Natural Mom

  13. Salam
    Thanks for your comprehensive Paper.
    I do agree that CS rate is alarmingly increasing in Saudi
    due to various reasons as u mentioned
    Fear of Litigation is highest and use of Electronic Monitoring
    Labour and Delivery should be staffed by Professional Midwives
    and also i noticed there is decreasing care and comfort measures given to the mothers during labour
    Once again a very good effort from you Madam
    May God Bless You
    Dr. Prabhavathi