Mothers and their families have lately expressed concerns that C-section births have become rampant, especially for those who deliver in private hospitals under the Linda Mama programme.
They believe doctors recommend the abdominal procedure so as to get higher compensations from the National Health Insurance Fund (NHIF) than if they were to conduct normal (vaginal) deliveries.
But medics deny the allegations, saying doctors are guided by their professional opinion and not monetary benefits.
Linda Mama, meaning "take care of the mother", is a state-sponsored insurance plan for pregnant women, while the NHIF is a health insurance fund for all Kenyan citizens.
Among those who suspect expectant mothers are being subjected to C-sections unnecessarily is a teacher whose wife delivered at a private hospital in Homa Bay county last month.
“I am really afraid that C-section has become the order of the day in delivery rooms,” the teacher told the Star, requesting anonymity due to what he said is his close relationship with the hospital’s owner.
“This is our fifth child; the rest were normal deliveries. Now, my wife has to endure the long, painful recovery process.”
A spot check by the Star at the facility found that out of seven mothers in the maternity ward, four had had a C-section.
The tutor suspected that C-section births are being recommended to many mothers so the hospital can benefit more in compensations by NHIF.
The NHIF disburses Sh17,000 to private hospitals for each C-section and Sh6,000 for normal delivery.
For both normal and surgical deliveries per person, public health centres receive Sh2,500; level 4 and 5 facilities Sh5,000, and referral hospitals Sh17,500.
However, Dr Michael Oduor, a Siaya county-based gynaecologist, says doctors are professionals and would opt for C-section to take care of the welfare of the baby and the mother.
“C-sections are done only when it has been professionally established that the mother and the baby are at risk. Money can never be a motivating factor,” he said.
C-sections are done only when it has been professionally established that the mother and the baby are at risk. Money can never be a motivating factor
RISK FACTORS
Doctors resort to C-sections if the passage is too small, the placenta covers the opening of the cervix or there is stalled labour, Dr Oduor said.
Other health conditions, such as high blood pressure and convulsions, may also necessitate a surgical procedure to deliver the baby, he said.
“There is no checklist that any woman who walks in with certain conditions or physical features will go to the theatre. Whether a mother delivers normally or by surgery depends on varied grounds.”
Dr Oduor dismissed the rumour that women who are shorter in height and wear certain shoe sizes are destined for theatre rooms.
He said Bondo Subcounty Hospital, where he works, delivers more than 300 babies every month, both normally and through C-section and, in the case of an operation, the decision is purely professional.
A senior midwife-nurse with knowledge on the operations of private hospitals, and who sought anonymity, said consent is always sought before any C-section is done.
"I doubt that monetary benefits would motivate a doctor to do what is unnecessary," she told the Star.
“Labour is an extremely painful process, though, and every expectant mother would want the quickest way out. In private facilities, if a mother requests for an operation, they are simply given a consent form.”
She said requests for surgical operations by mothers are mostly turned down in public hospitals.
“The obstetricians are very patient with the process, so long as the woman has been assessed and found fit for normal delivery,” said the Siaya county-based midwife.
This, she said, could be the reason public hospitals are producing less cases of C-section deliveries and private ones more.
She, however, believes that a woman’s physical features determine the mode of delivery.
“Those who are wearing shoe number four and below or shorter in height tend to have a smaller pelvis, yet the baby is always big at the time of labour. C-section is often preferred for them.”
Those who are wearing shoe number four and below or shorter in height tend to have a smaller pelvis, yet the baby is always big at the time of labour. C-section is often preferred for them
WHAT SURGERY ENTAILS
C-section is a process whereby the delivery of a baby or babies is made possible through incisions in the abdomen and uterus, not through the vagina.
Half the mother’s body downwards is often anesthetised to make the entire process painless.
The recovery process is longer compared to normal delivery. The mother has to put up with pain relievers, and risks abound.
According to Mayo Clinic’s health website, the risks may include surgical injury to other organs during the procedure, wound infection and blood clots, especially in the legs and pelvic organs.
Other risks are reactions to anaesthesia, heavy bleeding during and after delivery, an infection (endometritis) and intermittent memory loss.
Mayo Clinic says the earliest time a mother who had been operated on can resume sex is after six weeks.
The website states other reasons why a C-section would be recommended. These are: changes in the baby’s heartbeat, baby’s feet, shoulders or buttocks entering the birth canal first, a pregnancy of multiples, a section of the umbilical cord slipping first through the cervix and an active genital herpes infection.
MATERNAL HEALTHCARE
As a key pillar in President Uhuru Kenyatta’s Universal Health Coverage (UHC) goal, Linda Mama was introduced by the NHIF in public health facilities, private and faith-based hospitals in 2017.
A 2022 study titled ‘Perspectives of stakeholders of the free maternity services for mothers in western Kenya: Lessons for universal health coverage’, lists what the programme’s package included.
These are antenatal care, skilled delivery care, maternity, post-natal care, basic obstetric emergency care in case of complications, child’s immunisation, out-patient clinical services, laboratory tests such as haemoglobin, HIV and clinical treatment on an outpatient or in-patient basis.
The package also offers incentives, namely: baby washing basin, sanitary towels, slippers, diapers, wipes and cotton wool.
Responding to authors of the research paper, a health manager in Siaya county said due to Linda Mama, there is a “high turn-up of mothers for health services, improved general health to mothers and babies, and increased knowledge level for mothers as they attend education during clinics”.
Speaking to the Standard in 2020, NHIF chief executive officer Peter Kamunyo said it is true the number of C-section deliveries have increased, but the Linda Mama programme has benefited many who would not have otherwise had access to hospital delivery services.
As at 2020, NHIF had remitted up to Sh200 million to health facilities in compensation for C-section deliveries alone. From 2019 to 2020, out of 724,463 deliveries, 64,523 were C-section births.
This indicates an increase because between 2017 and 2018, when the Linda Mama programme awareness and implementation commenced, only 28,454 out of 321,113 births were by way of C-section.
