Bangladesh promoting midwifery to curb unnecessary C-section deliveries

By Md. Kamruzzaman

DHAKA, Bangladesh (AA) – Mohammad Mohiuddin, a businessman in Bangladesh's remote southern coastal sub-district of Patharghata, took his pregnant daughter to a private health clinic two years ago as the only government hospital in the region had very limited facilities and resources to serve nearly 300,000 people.

The doctor at the clinic prescribed cesarean delivery for his daughter, citing different health complexities though there were no midwives or qualified health staff at the facility.

“The male doctor conducted the cesarean delivery of my daughter, which was not comfortable at all for us. Later, we came to know that the same male doctor operates more than a hundred cesarean section (C-section) deliveries every month,” Mohiuddin said on the eve of International Day of the Midwife to be observed globally on May 5.

Speaking to Anadolu Agency, he added that the situation is still the same with no remarkable progress in the last two years.

So, tens of thousands of Bangladeshi women give birth to their babies through unnecessary C-sections due to the lack of midwifery services and the commercial attitude of some greedy physicians, according to reports.

A June 2019 report by the humanitarian group Save the Children noted that the number of medically unnecessary cesarean cases increased by 51% between 2016 and 2018 in Bangladesh.

Underlining it as “a massive boom,” the report added that the South Asian delta nation of 170 million people recorded an estimated 860,000 unnecessary cesarean operations in 2018 while up to 300,000 women who needed a C-section were unable to access the service due to poverty and lack of facilities.

The key findings of the report added that Bangladeshi parents paid $483 million in out-of-pocket expenses for C-sections in 2018 that were medically unnecessary.

- Boosting midwifery services

According to the government records, currently, 2,550 midwives have been serving across Bangladesh in 407 sub-district health complexes and 854 local government union sub-centers, while a total of 5,342 midwives have completed academic courses and registered by the Bangladesh Nursing and Midwifery Council.

Some 2,792 registered midwives, who are out of government employment, are currently serving under some private clinics and humanitarian organizations. A good number of them are also serving at Rohingya refugee camps in the country's southern border district of Cox’s Bazar.

Though informal midwifery services have been provided in Bangladesh for centuries by local women without any professional training or academic background, the service has been formally launched in 2010 by some non-government health facilities.

The official deployment of midwives at different government health facilities across the country began in 2018, according to official records.

Speaking to Anadolu Agency, Bangladesh Midwifery Society President Asma Khatun said they very often cannot provide quality services due to a lack of manpower in comparison to the needs of a huge population.

“In most cases, three to four midwives have to serve in every remote government health complex that covers tens of thousands of people. It’s really very tough, and due to lack of manpower, we fail to ensure quality services,” Khatun said.

She, however, noted that due to formal services in government health facilities for the last four years, people’s interest in normal delivery has increased.

“It is positive that with the expansion of our services, the rate of normal deliveries will increase. With the help of midwives, many mothers have delivered their second babies normally though they gave birth to their first babies through cesarean operation,” Khatun said.

Referring to overpopulation, lack of mass awareness, and commercial attitude of medical doctors, she added that midwives have a crucial role in serving pregnant mothers and their upcoming babies.

“We are waiting for a new circular of deploying 5,000 more midwives by the government soon,” Khatun said, adding that Bangladesh needs at least 20,000 midwives, while Save the Children has also recommended the deployment of 22,000 midwives.

- Role of doctors

Sultana Akhter Mitu, a midwife at a health facility in the capital Dhaka's Azimpur Maternity Hospital, told Anadolu Agency that the role of doctors in normal delivery is very significant.

“A pregnant mother mostly comes to a doctor first. The decision about cesarean cases comes from doctors and not from any midwife. All of our efforts are dedicated to normal deliveries,” Mitu said.

The report by Save the Children added that about 80% of all births in private hospitals in Bangladesh are now C-sections. “This is in part due to poor regulation of the medical sector and some unscrupulous practitioners, for whom doing C-sections is a profitable business.”

Mitu believes that government surveillance is crucial, but that the deployment of additional midwives at the grassroots level across the country is even more so.

Saying that a cesarean delivery causes life-long suffering for a mother and her baby, another midwife Syeda Mahfuza Jhumu, who is working at a remote sub-district health complex in the northern district of Mymensingh, told Anadolu Agency that the commercial dealing by some physicians must be checked for the greater interest of the new generation.

Speaking to Anadolu Agency, Dr. Md. Atiar Rahman, a child specialist and a professor at Bangladesh’s lone Bangabandhu Sheikh Mujib Medical University, said a child born through normal delivery is physically more fit than those coming through a cesarean operation.

“In most cases, a mother remains sick for several weeks after cesarean delivery. So, she could not care for her baby properly as the initial breastfeeding is hampered which is very important for every newborn baby,” Rahman said.

Calling unnecessary cesarean cases “very unethical” and “disrespectful” to the profession, he added that in the course and curriculum of medical studies, the moral lessons should also be incorporated.

He said the government should form a special committee having experts to oversee and regulate issues around childbirth.