C-sections have multiplied



Though up also in Estonia these past years, compared to some European countries our Caesarean section level is rather low and we do resemble the prudent Nordics. 

On Cyprus, every second baby enters this world by C-section. In Germany, every third. In Estonia, every fifth. «Such high percentages cannot just be pressure by women. This is also enforced by doctors as C-section is convenient, lasts mere 20 minutes and the fuss is small,» said Lee Tammemäe, head of women’s clinic at Estonia’s largest maternity hospital, East-Tallinn Central Hospital. 

Surgery risky

She thinks in some countries the large numbers of C-sections may be due to financing i.e. operational birth assistance is paid better. «In Estonia, at state hospitals, pay of doctors and midwives does not depend on that,» she underlined.

According to Ms Tammemäe, Estonian women have kept their wits like in all Nordics where C-sections are the rarest in Estonia. «A week ago, I met with doctors in Helsinki and they were also troubled that C-sections are beginning to increase,» she added. She went on to say that the Nordics do have good evidence-based medicine with few unnecessary procedures; even C-sections are not performed without medical reasons. 

She would not label C-sections as good or bad. «An unnecessary C-section means unnecessary hazards for mother and baby. But there are the situations where surgery is necessary, then it is the best option,» she Ms Tammemäe explained.

While with the initial C-section the risks and threats are not significantly higher than when giving birth, the risks will multiply with every following pregnancy. «After C-sections, cases of placenta accreta have significantly increased bringing about bleeding and need for removal of the uterus which are life threatening conditions,» said the doctor, to explain why the increase is worrisome.

Some two dozen years ago, Estonia had six percent of babies brought forth by C-section. By now, the percent is 21. «Six percent is obviously too little, just look at the mortality rate of newborn back then,» said the doctor. She explained that it is medically substantiated to end 14-15 percent of births with C-section, as this reduces sickness and deaths of newborns.

Ms Tammemäe said there have always been the women who, fearing to give birth, ask for a C-section. Such instances have slightly increased in Estonia, but are still limited to single rare cases. They are afraid of the labour pains, but today options are multiple for effective painkillers and for every mother there’s a suitable variant.

«Indeed we have performed a few such surgeries but the decision must be deeply substantiated, as an anxiety disorder cannot be cured by scalpel,» underlined Ms Tammemäe. A reason why Estonia’s C-section numbers are higher than in Iceland may be that lots of maternity wards are small. Statistics confirm that in smaller hospitals the probability of operations is higher.

As in smaller places there is no operation team present at the hospital and it takes time to summons operating room nurse and anaesthesiologist from their homes, this may be a cause to panic C-sections.

«There has never been a lack of specialists as critical as now, and in our field lots of departments only survive due to travelling doctors – having no staff of their own,» admitted the doctor.

«With so many C-sections happening in small hospitals, hardly can this percentage be reduced; but it would be good for the percentage to remain stable at around 20,» she reasoned.

Complex system

She said maintaining a maternity ward means having to offer a complex service; the hospital needs to possess anaesthesiologists, operating room nurses, blood service, a laboratory, the necessary diagnostics devices – as critical situations arise swiftly.

«The apparatuses to monitor the unborn and the mother are expensive, I am afraid a small department cannot even purchase all of that,» said the doctor. As advised by Estonian Gynaecologists Society, a maternity ward ought to have a minimum of 500 births a year to be cost-effective. 

«I think that things will go the way they do... and in five of ten years Estonia will manage with three large maternity hospitals, as every year the numbers of births are going down,» observed Ms Tammemäe.