WHO moves to tame rising cost in giving birth

By Gatonye Gathura

Alarmed over escalating cost of delivering babies, the World Health Organization has moved to bring back sanity into the process of giving birth.

Last week the world body made 56 recommendations to Member States which if observed could dramatically reduce the cost of giving birth.

WHO wants elective Caesarian births, instrumental vaginal births, pain blocking injections and early labour inducing medicines to be discouraged.

The influential body wants women to go back to natural pushing and reclaim the unique experience of giving birth.

“The increasing medicalization of childbirth has undermined the woman’s own capability and the unique experience of giving birth,” says Dr Princess Nothemba Simelela of WHO.

The recommendations, 26 of them new could tame what WHO calls too many and too early medical intervention including decisions to put women on the knife.

This comes when in Kenya public insurance reimbursements for Cesarean births or C-section have surpassed those for normal delivery.

Last year the National Hospital Insurance Fund’s (NHIF) paid Sh1.2 billion for C-section births taking 58.2 per cent of its maternity costs.

NHIF chief executive, Mr Geoffrey Mwangi, says payments for CS surpassed budgets with about half of delivering women shown to have gone under CS.

Mwangi says since NHIF does not pay for elective C-section, the huge claims are either an outright fraud or some doctors are deliberately encouraging surgical births for personal financial gain.

In August a study published by the research department of Kenyatta National Hospital showed attending doctors to be influencing women to go for repeat C-section deliveries even without pointing out risks.

Kenyatta hospital charges about Sh 53,000 for a normal birth and up to Sh152, 000 for a C-section.

While Caesarean births saves lives, WHO says in many cases it is being  performed without medical need, putting women and their babies at risk of short- and long-term health problems.

Medical reports show demand for CS births in Kenya to be on the rise especially due to an expanding middle class, employed women who are insured and hospitals keen on maximizing profits.

Demand for C-Section in Kenya is shown to have shot up dramatically since 2015 when the NHIF increased the reimbursement from Sh18,000 to Sh30,000.

This could rise further as NHIF takes over the funding of the free maternity programme across the country through the Linda Mama, Boresha Jamii programme currently awash with money from a Sh 19 billion World Bank loan.

Insurance companies have also complained over high rates of maternity fees which have more than doubled in the last decade mainly pushed up by what WHO is calling the over medicalization of a purely normal biological process.

Charges for both normal and CS deliveries rose by 90 per cent in major hospitals in the last six years to range between Sh100, 000 for normal deliveries and 270,000 for C-section.

Demand for CS has also been on the rise in public hospitals raising concerns of possible collusion over insurance reimbursements.

For example, a study published in November by the Kenya Medical Research Institute and the Ministry of Health showed rising preference for C section deliveries at the Mama Lucy Kibaki Hospital in Nairobi in 2015

Employed women were most likely to go for C-section at Mama Lucy hospital compared to their unemployed counterparts.

But even in the absence of C-section births, WHO says doctors are too quick to take to the knife, medications and other unnecessary interventions.

“The liberal use of episiotomy, for example may be linked to over-medicalization based on ensuring financial profits for practitioners,” says the WHO document.

Episiotomy, is a surgical cut made to enlarge the birth canal but now WHO experts say most doctors are too quick to take the knife even when the woman is going through perfectly normal labour.

The new recommendations take note of contradictions existing in poor countries like Kenya where on one hand poor women have too little care while the rich have too much most of it uneccerary.

The number one recommendation by WHO says all delivering women must be accorded respect throughout the delivering process.

The recommendation is based on among others a Kenyan study which showed high levels of disrespect and abuse of delivering mothers which has resulted to poor birth outcomes.

Princes Nothemba say if doctors changed their attitude on pain during labour as a normal occurrence they would reduce medicalization and empower women to rediscover their innate birthing capabilities.

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Some of current practices WHO want out

  1. Disrespect and abuse of delivering mothers
  2. Elective C-section births
  3. Too early admission for uncomplicated births
  4. Pubic shaving
  5. Baby heartbeat monitoring
  6. Cleaning of woman’s bowels (enema) before birth
  7. Pain relief for preventing labour delay
  8. Vaginal cleansing
  9. Antibiotics for uncomplicated vaginal birth
  10. Intravenous fluids for preventing labour delay
  11. Early deliberate rapture of the amniotic sac
  12. Early introduction of the hormone oxytocin

Some aspects WHO want encouraged

  1. Women should go back to pushing
  2. Every woman should be accompanied by a companion/spouse
  3. Skin-to-skin contact for mother and child

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