According to the most recent data released by the Ministry of Health, the rate of C-section births in 2009 was 39.3 percent for public hospitals, 61.8 percent for private hospitals and 63.2 percent for university hospitals. In 2010 these rates had increased to 40.2 percent, 63.7 percent and 65.2 percent. In 2011 rates stood at 36.8 percent of all deliveries in public hospitals, 66.6 percent in private hospitals and 65.9 percent in university hospitals, indicating a gradual increase in C-section surgery. C-section births have recently come into the spotlight after Prime Minister Recep Tayyip Erdoğan expressed his opposition to the surgery, describing it as unnatural, at a conference in İstanbul on May 25.
Erdoğan further attacked C-section deliveries as well as abortion, as “secret” plots intended to stall Turkey’s economic growth. Health Minister Recep Akdağ confirmed plans to limit the number of C-section births at Turkish hospitals during an interview one day after the prime minister’s remarks.
Drawing attention to the increasing number of C-section surgeries in Turkey, Akdağ said: “This may be explained by both the existence of avaricious doctors and the tendency among women to take the easy way out when giving birth. As a matter of fact, statistical data of the World Health Organization [WHO] suggests the ‘ideal rate’ of C-section deliveries is 15 percent, while in Turkey this rate is as high as 70 percent at some private hospitals. I think the ministry should come up with more effective solutions, such as not making insurance payments for C-section surgeries.”
Akdağ, who met with journalists on May 29, said: “Almost one in every two expectant mothers has their baby delivered by C-section,” further remarking that C-sections can entail complications for both mothers and babies. Akdağ added that C-sections should only be performed out of medical necessity and that the Ministry of Health plans to implement new measures against the perceived overuse of the surgery.
Speaking to Sunday’s Zaman, Chairman of the Turkish Society of Obstetrics and Gynecology (TJOD) Dr. İsmail Mete İtil stated that the rate of C-section surgeries is not only on the rise in Turkey but also in Europe and other parts of the world. “The average rate for C-section surgeries was 25 percent among Organization for Economic Cooperation and Development [OECD] countries [in 2009]. The highest C-section rates belonged to Turkey, Italy and Mexico, whose rates for C-section surgeries are above 40 percent. These countries are followed by the US and South Korea, whose rates are 33 percent.”
Stating that C-section surgery can be life saving when vaginal delivery poses any risks to the health of the mother or the unborn baby, İtil added that C-section surgeries should not be favored without medical necessity.
Elaborating on the possible causes of increasing rates of C-section surgeries in Turkey, İtil speculated one reason may be the fear of natural birth without the aid of medication. He further suggests that pain-reducing techniques or medications are not commonly used during natural births in Turkey.
According to İtil, the Ministry of Health should take measures to decrease the number of C-section surgeries, but he notes that TJOD had previously proposed some possible measures to be taken by the Ministry of Health to achieve this result. The list of proposals provided by İtil are as follows: The number of midwifery schools should be increased and midwife-assisted births should be encouraged; both married and single women should be educated about childbirth in order to eradicate common misconceptions; pregnant women with intense fear of giving birth should be provided with psychological support and guidance; natural vaginal childbirth deliveries should be promoted in the media and pregnant women should be informed about the risks of C-sections through social media projects.
İtil further considers the possible role of doctors in the decision to give birth by C-section surgery, stating: “The growing number of C-sections in Turkey might also be the result of some medico-legal issues. Gynecologists are the medical practitioners required to pay the largest sums in compensation due to malpractice suits arising from natural childbirths, so they tend to avoid them and encourage women to undergo C-section surgery. They fear being liable to pay compensation.”
Retired Gynecologist Dr. Turgay Karakaya, speaking to Sunday’s Zaman, emphasized the role strict penalties for medical malpractice is playing in high rates of C-sections.
Karakaya stated that gynecologists can sometimes face compensation lawsuits up to TL 2 million in Turkey, which intimidates gynecologists and may cause them to acquire the practice of advising pregnant women to undergo C-section surgery instead of natural birth.
“The penalties for malpractice are very heavy, which worries doctors. Each delivery carries some risks. Sometimes problems can occur during the delivery through no fault of the doctor, but such incidents may be considered malpractice and in those cases the doctor faces a large sum in compensation,” Karakaya noted.
However, Karakaya granted that C-section surgeries also pose some risks for babies. “Women who deliver their babies by C-section surgeries recover far more slowly than women who give birth by vaginal delivery,” Karakaya adds.