Thailand has double the recommended rate of surgical births, and that could be a problem, say experts
THOUGH THE story of Mae Nak Phra Khanong, a woman who died in a difficult childbirth over a century ago, no longer scares Thai mothers-to-be, nearly one out of every three babies still arrives via C-section in Thailand.
The reason for this is that mothers choose to go under the knife due to fear of labour pains, superstitious beliefs or to take advantage of the packages offered by private hospitals.
“In Thailand, 35 per cent of all babies are born by caesarean section, but the World Health Organisation puts the ideal rate at 10 to 15 per cent,” Professor Dr Pisake Lumbiganon, president of the Royal Thai College of Obstetricians and Gynaecologists, said.
The high rate of C-sections in Thailand, he said, can be attributed to a lack of health literacy, as most women -– including those working in healthcare – believe a C-section is safer and better than natural delivery. Also, Pisake said, going under the knife allows parents to manage their time and choose a lucky date of birth.
One mother, who asked not to be named, said she chose surgical birth due to fear of labour pains.
“After we made the decision, we went to a venerated abbot and had him pick a date. He chose a holiday, which was also very convenient for us,” she explained. Her son was born on December 5 – the birthday of late King Rama IX.
Likewise, Kedsanee, a nurse at Bangkok Hospital Pattaya, said she had given birth to a healthy boy via C-section.
“The obstetrician himself picked the date for me. It was the 6th day of the 6th month in year 61. He said number 6 was lucky,” she said. Her son was born on June 6, 2018 or 2561 BE (Buddhist Era).
The belief that a person’s birthday determines the course of their life is prevalent in Thai society, especially among well-to-do people and celebrities who can afford to cover the costs of a C-section.
Chompoo Araya Hargate, a top Thai celebrity, and her billionaire husband, for instance, had renowned feng shui master Grienggrai Boontaganon set the delivery date for her.
And she is not alone.
According to Chinese belief, as soon as sunlight touches a baby’s skin, the wheel of fortune is set in motion, Grienggrai told The Nation Weekend.
However, he said, it is difficult to come up with an auspicious date and time. “They comprise five elements – good health, prosperity, supportive relationship, parents’ prosperity and a smooth life – and there are very few dates that yield all of these.
“Many people are naturally born on fortunate dates and became millionaires. But natural birth is like a game of chance – if the baby is born on a bad date, they may encounter setbacks in life,” he said.
Famous fortune-teller Arunwich Wongjatupat said nine out of 10 parents look for dates that will yield either prosperity or leadership qualities for their soon-to-be-born child. According to Thai belief, the stars begin affecting our life as soon as the umbilical cord is cut, he explained.
Some “stars”, such as the Moon, can bestow charm and attractiveness, while some can make the parents prosperous.
“One thing that I find really repulsive is that lots of parents want their child to be born on a date that will help their business, even if the baby is not ready for delivery,” Arunwich said. “We need to put the health of the baby first.”
Doctors, meanwhile, are expressing concern that auspicious dates chosen by fortune-tellers are often too early for the baby.
Onjira, who has Chinese ancestors, had her twins delivered by C-section at Bangkok’s Bumrungrad Hospital after a Chinese fortune-teller picked several auspicious dates for her. One date fell in week 37, three weeks before a woman can give birth naturally.
“Many doctors give in to patients and schedule the delivery as early as week 37,” confirmed Assoc Professor Dr Nopadol Sorapala, an obstetrician at Bumrungrad Hospital. He said natural childbirth usually occurs at week 40, but international guidelines set elective delivery at week 38 onwards. “The closer to week 40, the better. Don’t sacrifice your baby’s health just to meet the lucky date,” he warned.
A study published in the New England Report in 2009 looked at elective C-sections among mothers with a C-section history, and concluded surgery should be scheduled at week 39 at the earliest. The study found that babies born by C-section at week 37 are twice as likely to have breathing problems, low blood sugar and infection compared to those born in full term. Premature babies are also more likely to be admitted to the intensive care unit.
But factors that make caesarean sections so popular in Thailand are not limited to the parent or the fortune-teller. Doctors and hospitals also play a part. According to Nopadol, most doctors prefer caesarean surgery to natural delivery because “it is faster, more convenient, less tiring, and more profitable”. In natural delivery, doctors may have to stay overnight before the baby is delivered, but a C-section can be completed in 45 minutes, he said.
Pisake said that since seven out 10 babies are delivered by C-section, private hospitals can charge almost twice as much for caesareans instead of natural delivery. At Bumrungrad Hospital, one of the top private hospitals in Bangkok, parents pay as much as Bt136,000 for a C-section compared to Bt89,000 for natural delivery.
“At least half of the C-sections, or about 100,000 births, take place without medical reasons,” Pisake said. “This is a big waste of resources, because the surgery doesn’t improve the baby’s health, but may in fact threaten it.”
According to Pisake, unnecessary C-section deliveries can also complicate future pregnancies and extend the mother’s recovery period.
Instead, he said, parents and doctors should only go ahead with a C-section surgery when a medical necessity arises, such as when the baby is wrongly positioned or the mother is bleeding from a low-lying placenta. Other necessary interventions could include obstructed labour or insufficient oxygen reaching the baby. Pisake said some studies suggest that babies delivered naturally have better immunity and are less likely to develop allergies later in life, because they receive good microbes that inhabit the mother’s birth canal, which inoculate the baby as it passes through.
If done properly, he said, a natural delivery is safer for both the baby and the mother.