Everything is chosen carefully: a small bed, bottles and a silky hairbrush. Pink clothes for the day of delivery and a white dress for the week’s party have also been selected. Baby Massa was the only one left behind in hospital, undressed and confined to a glass box incubators so she could breathe.
Massa spent seven days with her limbs attached to medical devices through wires and with a tube going through her nose immediately after her birth. The newborn baby girl was transferred from the ventilator to the nasal oxygen cannula device, then to the incubator for more oxygen. An x-ray of her heart was carried out, and she had to undergo daily examinations and analyses. She had to receive injections and intensive doses of medicines until she was able to breathe naturally on her own.
Massa and her mother, Aliyya, were “victims” of an unnecessary Caesarean section. One of the most prominent consequences of this procedure is the inability of newborns to breathe spontaneously, and some need to be put in incubators, which entails great health risks and financial costs.
This investigation is based on a questionnaire designed specifically to discover the reasons behind the unjustified rise in the rate of Caesarean sections operations carried out in Egyptian hospitals. The investigator discovered that eight out of ten women were subjected to such procedures between 2014 and 2020 based on responses collected from 6500 women. The period in question was not covered by any official health surveys. The findings of this investigation have noticed a considerable increase compared to the last available official health survey collected in 2014 showing that five out of every ten pregnant women had to undergo a C-section operation to deliver their newborn,
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According to the World Health Organization WHO, Egypt ranks fourth in the world in the table of highest number of C-section operations carried out. The questionnaire also shows that half the number of children born via Caesarean section suffered from complications after birth, and one in five children needed an incubator, while one in five mothers experienced health complications.
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Aliyya did not want to undergo a Caesarean section; she had planned for a natural birth that she knew would be best for her and for her baby, especially since her pregnancy was stable and the fetus’s position in the pelvis was favorable. Unlike the case with other women, labor pains did not scare her as much as the idea of having her abdomen opened.
The doctor though seems to have had other plans. Aliyya remembers how terrified she was when her doctor told her, “If you do not give birth by a Caesarean section, you will be responsible for the safety of the baby. If she dies, we will open your abdomen anyway to get the baby out.” The doctor did not mention any medical reason for Aliyya to give birth by a Caesarean section, although two weeks remained until her baby was due and despite previous assurances by the same doctor that her child was in a natural birth position.
84%The doctors decide
16%The mothers decide
Massa was unable to breathe normally from the minute she was born, and her body turned blue. The situation was critical, and the little girl needed an incubator immediately. She was slightly better off than 25% of the children whose mothers participated in the questionnaire and who faced difficulties in finding incubators. Her family did not need to resort to searching for incubators or to wait for long hours while the baby’s life was at risk. They opted for an incubator in the private hospital where Massa was born, even if the cost was beyond their means.
The cost of incubators vary depending on the entity that provides them; some charitable health organizations provided these either for free or at a low cost. Incubators provided by the public health service are the least expensive after the ones provided through charity, but they are also the most difficult to come by when you need one. This forced the families of four out of every five newborns to resort to source an incubators from private sector providers for a high cost.
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50children born through Caesarean sections25 had complications
8 sourced private sector entity
2 provided by public sector
النسبة هي 20% وهذه عينة تمثيلية
In February 2020, Fayez Barakat, Member of Parliament, submitted a request for a briefing to the Minister of Health. He demanded that unnecessary Caesarean sections be controlled, as these were the reason for the shortages in incubators. He also called for a legislative amendment that commits doctors to writing a medical report explaining why they must resort to a Caesarean section to be reviewed by a specialized panel before the surgery. Barakat stressed that the increase in the rates of Caesarean births is matched by an increase in the need for incubators, especially that a large percentage of Caesarean sections are performed at an earlier date than the due date. Then, the family’s journey of suffering begins as they search for available incubators, given their scarcity in the public health service, and the high cost of renting one from private providers or hospitals.
Dr. Rabab Ali, a specialist in pediatrics and neonatology, says, “A natural delivery helps to strengthen the fetus’s heart and activates its lungs to enable it to exit the womb and to breathe normally, which is a stimulus that Caesarean deliveries do not trigger.” She stresses that “babies delivered through Caesarean sections are more prone to respiratory problems and more likely to need incubators.”
Dr Ali is alarmed by the method of transferring newborns from clinics and hospitals to incubators; she says, “Transferring babies without appropriate medical equipment may expose them to shortage of oxygen that may cause cardiac complications. This, in turn, may lead to mental and motor disabilities or convulsions.” She pointed out that the worst cases required access to incubators where she works were usually transferred from private clinics and hospitals that do not have incubators.
After an exhausting journey, Massa made it to her pink bed at her parents’ house. Her tiny body was colored with bruises and blood pooling in the spots where she was injected for samples and analyses. The incubator charges reached 1100 Egyptian Pounds, that is around $70 per night, in addition to the cost of medicines, tests and x-rays.
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The Ministry of Health has acknowledged that there is a huge increase in Caesarean sections operations and recognized the risks these pose to the health of mothers and newborns based on a study published in 2018, “Caesarean Sections in Egypt: Trends, Practices, Perceptions and Cost” that was conducted with the participation of the Egyptian Ministry of Health, the Population Council, the World Health Organization and the United Nations Population Fund.
A study published in the Egyptian Journal of Hospital Medicine tracked births at Banha Teaching Hospital: These amounted to 1500 cases in six months of 2018, 65% of the births were through Caesarean sections. Twenty percent of those born by a Caesarean section had complications that required placing them in incubators, and half of them had respiratory distress. This was followed by meconium aspiration; meconium is the first stool produced by an infant and consists of materials that were digested when the baby was still in its mother’s womb. Other cases included sepsis and neonatal jaundice. Newborns stayed in incubators between three hours and twelve days, and ten deaths were recorded.
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The doctor who was following up on her case would confirm to her that she had a great chance at a natural birth, and she prepared herself for that. Later, she had to follow up with another doctor who insisted on delivering the baby by a Caesarean section in the 36th week of her pregnancy without medical justification.
Marwa suffered from severe hemorrhage that lasted for more than fifty days, which led to a deficiency in red blood cells and to anemia. This is in addition to problems with bowel movement that prevented her from passing stool for twenty days, which led to initial poisoning. Her wound also remained open and inflamed, oozing pus, and it is still under treatment.
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According to the study published in the Egyptian Journal of Hospital Medicine, 19% of mothers who delivered through a Caesarean section experienced complications during delivery. Most notable of these is a wounded uterine artery in 10% of the cases, followed by hemorrhage, adhesions, hysterectomies, and wounded bladders or intestines. Ten percent also experienced complications after childbirth, with fever being the most common, followed by cuts and bleeding.
Marwa says, “At the beginning of my pregnancy, I searched a lot for a doctor who would not perform a Caesarean section without a valid reason, and more than one doctor would say they did not have time for a natural birth.” She continues, “My doctor refused to attempt a natural delivery despite my request and decided on a Caesarean procedure. All those who gave birth when I delivered and until I was discharged from the hospital did so by a Caesarean section.” The Health Survey indicates that out of every ten women who gave birth in a private hospital, seven of them delivered by a Caesarean section.
