Selma Usul, who was pregnant with a girl weighing around five kilograms, was taken to Nazilli State Hospital when her labor began last week. Dr. Haluk Uçkan decided on a normal birth but after the baby's head emerged, the birth became problematic and it was then decided to perform a Caesarean section. During the Caesarean section, doctors were not able to dislodge the baby's head and claimed that the baby died during the operation. To save the life of the mother, the doctors then decided to remove the head of the baby. But the family has claimed the opposite happened and said the baby was "decapitated" before she died. Public prosecutors have opened an investigation into the incident. The incident has set off much discussion. Many experts have already pointed out that a baby weighing five kilograms should not have been delivered by cesarean section. The Ministry of Health has opened an investigation into the case; meanwhile experts are underlining that the restrictions on Caesarean sections could lead to further problems.
The Ministry of Health issued a statement this year, declaring that from Sept. 1 the number of Caesarean sections at a health institution will be taken into consideration when calculating the performance of hospitals. Pursuant to this statement, Caesarean sections should be no more that 20 percents of all births in research and training hospitals and no more than 15 percent for other hospitals. If the Caesarean sections in a hospital are higher than these levels, hospital funding and staff pay will be cut.
According to Turkish Ministry of Health statistics in 1998, Caesarean sections as a proportion of all births were 14 percent and 21.4 percent by 2003. But these numbers have sharply increased recently: 40.7 percent in 2005, 40.3 percent in 2006 and 42.5 percent last year.
The Ministry of Health wants to reduce this number to 25 percent and to reach this goal it has started to implement a program with the slogan, "Every pregnant woman should be given the chance to give birth naturally." It aims to restrict Caesarean sections only to those who medically need them.
But since the implementation of this program, doctors have been discussing the subject. Some are claiming that the money which is being spent to deal with complications resulting from normal births is higher than the expenditure for Caesarean sections.
Doctors are critical of the program from the Ministry of Health, claiming that decisions regarding Caesarean sections can be taken only by doctors and to question it is unethical.
Professor Turgay Şener, the chairman of the Turkish Perinatology Association, has said any directions from the Ministry of Health will not be useful in reducing the amount of Caesarean sections. "Restrictions can lead to disagreements between doctors and patients. If there is even a small problem, the patient will ask the question if it was because of the normal birth. The doctors will feel pressured and will choose normal births in some cases where cesarean sections are better," he underlined.
Turkish Gynecology and Obstetric Association Chairman Bülent Tıraş has suggested that the number of Caesarean sections will affect the performance of the whole of the hospital and have an impact on other doctors' pay, so this may put pressure on gynecologists to choose normal births.
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