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this story is part of the 19-23 Feb 2018 Weekly Hindsight Read the hindsight

C-sections mean more to Romanian women than you'd suspect

Delia Budurca recommended by Delia Budurca NewsMavens, Romania

Almost 40% of Romanian women give birth by Cesarean section and in Bucharest this rate exceeds 60% -- far more than is medically justified. Why do women choose this method?

Romania Aha moments

Why this story matters:

Theoretically, a C-section is an operation performed when natural birth involves a major risk to the baby or to the mother. According to the WHO, it should be the exception to the rule and should not be recommended as a convenient alternative to natural birth.

However, due to higher revenues for hospitals and doctors, the absence of pain, mother's fear of birth, doctor’s fear of malpractice, scheduled delivery, risk control and fashion, many women opt for this method of delivery. 

But this is not the whole story in Romania. C-section was in fact an indirect contraceptive method before the Revolution of 1989.

Nicolae Ceausescu's pro-birth policy from 1966 to 1989 forbade abortions, but women could have a legal interruption of pregnancy after two C-sections. Many say that's when c-sections became a popular form of birth in Romania -- they offered women a choice whether to have legal abortions later. Experienced Romanian obstetricians claim that after 1989 the popularity of the procedure continued to grow. Even though the connection of c-sections to legal terminations was void, they had taken root as the best and most luxurious way to deliver.

This story is therefore not only about a trend, but also about an inheritance from the communist times that remains deeply embedded in Romanian mentality.

health, women's issues

Details from the story:

  • The World Health Organization (WHO) recommends that the percentage of births by C-section should not exceed 10-15%, this rate being associated with the lowest risks. In some Bucharest hospitals this rate is close to 80%.
  • At the same time, Romania has the highest maternal and infant mortality rate in Europe. According to the National Institute of Statistics, 8 out of 1,000 births end with a tragedy.
  • There is no protocol in Romania regulating the access to C-section. Thus, the doctor has a free hand to lead the patient in the way he wishes. That's how some gynecologists disinform pregnant women to get a C-section.
  • In communist times, more than 10,000 women have died following illegal abortions.
  • After the Revolution, Romania recorded the largest increase in C-sections in Europe: over 29% (from 7,2% in 1990 to 31,3% in 2012 and to 36,3% in 2016).
  • However, although it is often presented as a simple intervention, the incidence of post-C-section complications is more than 16 times higher than after a natural birth.
  • In Bucharest, statistics show that the rate of C-sections increases each year, reaching 68.5% in 2016.
  • In a private hospital a C-section costs around 2000 euros, twice as much as a natural birth. The same is true in state hospitals, but we are talking here about informal payments.
  • Currently, a C-section is reimbursed on average up to 948 lei ($ 248), according to data from the National Health Insurance House website. The same amount was confirmed eight years ago, in a WHO study, which estimated that Romania was spending over $ 4.5 million a year on these operations.

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