While expecting her first son almost five years ago, Taing Bunsothea, 29, made the choice to have a cesarean section instead of a natural birth because friends had told her a natural birth would be very painful, and she wanted her child to be born on a day that would give him good fortune.
When her second child, a daughter, was born six months ago, Ms Bunsothea, a teacher at Bak Kheng high school, opted again for a luck-bringing cesarean, paying about $800 for the c-section procedure, which included a one-week stay at Phnom Penh’s Bayon clinic, she said.
Although she didn’t have a medical reason to choose a cesarean, Ms Bunsothea said she wanted to avoid the hours of pain and labor in childbirth, and that her doctor had informed her that a c-section would be just as safe even though it carried with it some risks.
“My family, especially my mother, believes that babies born on the 9th, 19th or 29th of the month are the best days… any child born on those days will grow up and will have a bright life,” Ms Bunsothea said.
“I don’t think having a c-section will harm my life or my children. The doctor claimed there are some negatives…. He stressed that the bad impact of c-section is that I can not have babies very often or a lot,” she said. But, she added, she already has two children and is not planning on having more.
Im Sochivy, 30, chose to have a cesarean after she had waited 13 days beyond the planned delivery date for her first son who was born two years ago. She had also found that he was a big baby, weighing about 4.4 kg, and that it would hurt more if she had a natural birth. Many of her friends also had c-sections, she said, because they too didn’t want to go through the painful delivery and because they wanted to decide on what day their child should be born.
Her second cesarean birth was, Ms Sochivy admits, more about earning luck.
“Then I decided to have it again for my…daughter because my mother also wanted the child to be born in good time and a good fortune day,” she added.
According to health officials, an increasing number of better off women in Phnom Penh and elsewhere in the country are choosing to have cesarean sections before a natural birth to avoid the pain of labor, but also as important is the chance to earn some good feng shui by having children on an auspicious day.
Official numbers from the Ministry of Health suggest 2 percent of women chose to have a c-section; the vast majority of these women living in and around Phnom Penh. But since most private clinics don’t report their numbers the actual rate for c-sections in Cambodia is likely to be a lot higher, said Dr Muong Tito, secretary-general for the Association of Private Hospitals in Cambodia.
The process is akin to checking in at a hotel with rates varying between $450 and $850 for the c-section procedure which includes a stay of several days depending on what clinic the expectant mother chooses and what standard of room she may want, Dr Muong said.
Women opt for surgery because they want their babies born on a certain, auspicious day or because they are frightened about how a natural birth would affect their life afterward, but rarely because they face risk to themselves or their child if they had a natural birth, he said.
But for most women in Cambodia, and often those who really need one, a cesarean section is not available.
The lack of proper clinics to perform c-sections in rural Cambodia contributes to the country’s high maternal mortality rate. Five women in Cambodia die every day in childbirth according to the most recent UN statistics released in March.
The World Health Organization estimates that any given country should have a c-section rate of between 5 and 10 percent in order to guarantee all women who need an operation have access to it.
Dr Niklas Danielsson, medical officer for child and adolescent health at WHO, said that if it wasn’t for the large number of women in cities voluntarily choosing to have cesareans, for luck or comfort, Cambodia would fall far short of the minimum 5 percent required by the world body. Thus, those choosing to have c-sections are not the women who need them, and in fact, such women may be putting themselves in danger.
“[C-sections] that are done in the absence of the proper indications will of course not contribute to reducing the risks. Rather, they will increase the risk since a planned [c-section] carries slightly higher risks of complications than does normal deliveries,” Dr Danielsson wrote in an email message.
A cesarean is a major surgery and, like all surgeries, it carries certain risks, he said.
But that “risk is justified when you are faced with situations that carry much higher risks for the mother and the baby, such as obstructed labor,” he added.
And not only is a c-section risky, it may even be more painful than old fashioned labor pains.
Studies on women who have had both types of deliveries suggest cesareans actually give mothers more pain and a longer recovery time, according to Dr Jerker Liljestrand, a gynecologist working for Unicef. Instead of having pain during a few hours at birth you have the pain spread out over the following days, he said.
One reason for c-section overuse in some countries such as Cambodia is the economy factor for private clinics. Private obstetricians prefer c-sections since they can be rapidly performed instead of waiting hours or days for a natural birth, said Dr Liljestrand, who was formerly director for maternal health at WHO.
Women who choose to have a cesarean are more likely to get infections after birth, they are more likely to have problems with getting pregnant again and a woman could risk a uterine rupture due to uterine scarring, Dr Liljestrand said.
“A very serious aspect of [c-section] is the risk of maternal complications both at the current birth and, what is often forgotten, at the next delivery,” Dr Liljestrand added.
When the baby passes through the birth canal its chest compresses naturally, empties the lungs of fluid and prepares the child for its very first breath. Babies born via c-section are more likely to have respiratory problems after birth even though these problems are usually mild, he said.
Dr Tito, who is also director of Phnom Penh’s Panhasak Polyclinic, also agreed that unless there were complications in the pregnancy that requires a c-section a natural birth is better for the baby.
“[After] a c-section the child might face problems breathing because if born naturally from the mother, the child would have had a good breathing process,” he said.
When asked to comment on the official statistics and the numbers of cesarean sections in Cambodia, Dr Saing Sary, director for the Ministry of Health’s department of hospitals, said he was aware many women choose to have a c-sections but referred all other questions to Dr Kum Kanal, director of the National Maternal and Child Health Center.
Dr Kanal declined to speak with a reporter when contacted by telephone Sunday.