Cesarean section surgeries in childbirth can be key to health. But also during the last decades it is known that some practices are carried out without being justified. In Neuquén, a study was carried out that shows how this type of surgery has increased. In the last twenty years, cesarean sections went from 22.2% to 48.5% of deliveries that take place in the province.
The study was carried out by professionals from Neuquén and published in the Argentine Journal of Public Health, who edits the Ministry of Health of the Nation. They carried out a survey on the situation of both the public system and the private subsystem and, from now on, it is necessary to carry out a qualitative and specific analysis for each area.
Doctors Martín Sapag Fernando Vargas, Santiago Hasdeu, and obstetrics graduates Denise Sacomandi and Elizabeth Puentes, among others, were some of the members of the team that carried out the investigation, and explained to BLACK RIVER Journal why they did the study.
The baby also prepares for delivery from days before the time when it happens naturally. It is clear that the elective caesarean section interrupts or prevents this preparation (Photo file Mati Subat)
The five Sanitary Zones that exist in the province of Neuquén with ten hospitals and the private subsector were taken into account. Although it was observed that the global, national and provincial trend of cesarean sections was increasing, it was not known to what extent it occurred in the different parts of the province. “With the data, what is done is to transform it into knowledge, which is the first step. From there you have to go to action ”, described the pediatrician Sapag.
When medically justified, a cesarean section is an effective surgery to prevent problems for mother and baby. However, the benefits of cesarean delivery for women or neonates for whom cesarean delivery is unnecessary are not proven.
In the study they did in Neuquén, the results showed that the provincial average of cesarean sections in the year 2000 was 22.2%. In 2020 it was 48.5%.
While in the public subsector in the same period it went from 14.1% to 32.9% and in the private sector from 40.2% to 66.6%. Once the results are obtained, space is left to reflect on what is happening and make them available to the work team of each hospital or clinic.
The team studied the evolution of births between 2000 and 2020. “It is an incredible epidemiological transition, there is a very strong change. In 2000 there were between 10 and 12 thousand births per year and now they are below 7 thousand. The birth rate dropped and there is a change among women because it decreased a lot in adolescent mothers and rose in women over 35 years of age, ”explained Sapag.
In this analysis, the reality about the birth of babies by cesarean section is observed. “It is not the same throughout the province: there are very significant differences and they have increased over time,” he said.
In Neuquén the birth rate dropped between 2000 and 2020.
To answer the question of the reason for this increase is that they work with a “methodological triangulation”. There you will see the variables that must be considered, among them, how the gynecology-obstetrics sector is managed in each institution.
As an example, the Cutral Co public hospital service had the highest level of caesarean sections until 2020 and today that percentage reaches 36%. “Then there is a work success, from looking at reality and proposing improvements,” the doctors described.
Dr. Vargas, in turn, explained that when observing the results, they warned that the amount of medical resources does not have so much to do with it, but that each one fulfills their role in childbirth care. He said that “obstetrics graduates have generated a human resource that is specific to childbirth care.”
After looking at the numbers, One of the proposals that emerged is that of teamwork, with very specific roles: obstetricians, obstetricians, and nurses to attend not only the delivery but also the pregnancy. “You have to understand that the first most important person on that team is the mother,” Vargas said.
It was Denise Sacomandi, a graduate in Obstetrics, who reflected on the result of this work, not as a mere number or percentage, but rather a more in-depth, “multi-causal and qualitative” analysis.
The health teams involved in a birth do not all work in the same way and do not have all the human resources. As an example, he described that a private clinic does not have obstetricians among its staff, so it cannot be compared with another center that does have it among its resources.
The figure of the obstetrician was highly questioned and there are places where it is still highly resisted. “Today we are better inserted in the system, but it has not been easy for us. It cost us a lot,” she said.
Another issue to be addressed is, for example, in those cases in which mothers seek a birth when they have previously had one or two caesarean sections. That situation limits medical teams. It usually occurs with mutualized mothers who turn to the public to look for the birth, but have a previous cesarean section.”It is a determining factor and that also influences the cesarean section rates when registering,” she clarified.
Teamwork
Sacomandi raised another of the variables and that is to have a “solid team that is maintained over time.”
In those places, especially in the interior of the province, where there is a high turnover of professionals because there is a shortage of doctors, it is not easy to maintain the same line of work. This happens because the looks with which childbirth is approached on each occasion are even different. «Many times we want to work with a respected labor and birth and it gets complicated. So it is important to consolidate the health team »said.
A priori it can be thought that in the private subsector the rate of caesarean sections is higher and the statistics show it. However, the reasons are various as they clarified at all times.
The doctor Sapag said that the work allowed “to look at the current reality and respond to that reality, beyond global processes and that does not mean that the actions are local.” So, the task is “with the available resources, we have to organize ourselves properly to resolve the situation”.
Professionals agree that the reasons why cesarean sections are performed are diverse. There is a possibility that the private provider does not develop the team because they do not have the resources to do so and “the gynecologist is only making decisions.” In the north of the province, it is more difficult for medical personnel to arrive. However, obstetric women have a preponderance in team decisions and this lowers the number of cesarean sections.
“Sometimes it is not so easy to reach an agreement because it implies financing, agreement of the parties, a process of maturation of the services. But the important thing is to look at the reality of each place”, concluded Sapag.
The figure of the obstetricians
“It is fundamental for this to improve, the training of professionals and respecting the autonomy and competences that we graduates in Obstetrics have. The work is to protect the health and rights of mothers and babies, with a more loving and supportive treatment and not so much since the intervention,” said Sacomandi.
All the professionals recalled that the respected childbirth law has been in force since 2004 and that mothers are increasingly more informed about their rights at the time of giving birth. This implied a strong dissemination task within the institutions and to the community.