C-sections spike at Bara because of HIV-Aids

A spike in demand for caesarean sections has seen military medics pitching in to deliver babies at southern Africa’s biggest hospital.

At Soweto’s Chris Hani Baragwanath Hospital, about 600, or 30%, of the approximately 2000 women giving birth there each month undergo C-sections – a practice blamed largely on HIV and Aids as well as underqualified staff in surrounding clinics.

Late last month, five operating theatre-trained midwives from the military medical corps were deployed to the institution.

Hospital chief executive Johanna More said the situation had become so bad that “back-to-back emergency C-sections” had become the order of the day.

“The number of high-risk pregnant women who need to deliver by emergency C-section suddenly peaked. We had to do more caesareans than usual and needed more theatre-trained nurses to assist as some patients were complicating due to underlying conditions.”

Obstetrics operating theatres are supposed to have four nurses, including a midwife, working with a gynaecologist.

Baragwanath was struggling with three nurses, and sometimes two, as a result of a countrywide shortage of health professionals.

The increase in the number of C-sections has been attributed to the World Health Organisation guidelines which recommend the procedure to be considered in cases where pregnancy complications may be associated with an increased risk of HIV transmission from mother to child.

Although More could not provide comparative figures for previous months, Health Minister Aaron Motsoaledi said Baragwanath’s situation was aggravated by an “avalanche” of emergencies sent by surrounding clinics and hospitals which didn’t have the staff to deal with them.

“It is a known fact that Bara is facing staff shortages. It could not cope,” he said.

“Every pregnant woman who has complications is sent to Bara for an emergency caesarean. If we had specialists like obstetricians and advanced midwives at district level this would not be happening.”

However, Motsoaledi believed the HIV guidelines were being “overused”.

While about one in five babies were delivered by C-section in government hospitals, up to 70% were delivered surgically in private clinics.

South Africa has for years exceeded the international norm of between 10% and 15% of births by caesarean section in the private sector. But for the past two years, it exceeded that rate in the public sector as well.

Private sector Johannesburg gynaecologist and fertility specialist, Dr Herman Netshidzivhani, said the private sector rate was “alarming” as it was a “major operation” being performed on many who did not need it.

“More doctors opt for caesareans because of their convenience and they are trying to avoid lawsuits that may come as a result of complications during natural birth.”

- City Press