Scalpels Throw Newborns in “Unavailable” Incubators

Aliyya did not want to undergo a Caesarean section; she had planned for a natural birth that she knew would be best for her and for her baby, especially since her pregnancy was stable and the fetus’s position in the pelvis was favorable. Unlike the case with other women, labor pains did not scare her as much as the idea of having her abdomen opened.

The doctor, though, seems to have had other plans. Aliyya remembers how terrified she was when her doctor told her, “If you do not give birth by a Caesarean section, you will be responsible for the safety of the baby. If she dies, we will open your abdomen anyway to get the baby out.” The doctor did not mention any medical reason for Aliyya to give birth by a Caesarean section, although two weeks remained until her baby was due and despite previous assurances by the same doctor that her child was in a natural birth position.

Massa was unable to breathe normally from the minute she was born, and her body turned blue. The situation was critical, and the little girl needed an incubator immediately. She was slightly better off than 25% of the children whose mothers participated in the questionnaire and who faced difficulties in finding incubators. Her family did not need to resort to searching for incubators or to wait for long hours while the baby’s life was at risk. They opted for an incubator in the private hospital where Massa was born, even if the cost was beyond their means.

The cost of incubators vary depending on the entity that provides them; some charitable health organizations provide these either for free or at a low cost. Incubators provided by the public health service are the least expensive after the ones provided through charity, but they are also the most difficult to come by when you need one. This forced the families of four out of every five newborns to resort to source incubators from private sector providers for a high cost.

The Ministry of Health has acknowledged that there is a huge increase in Caesarean sections operations and recognized the risks these pose to the health of mothers and newborns based on a study published in 2018, “Caesarean Sections in Egypt: Trends, Practices, Perceptions and Cost” that was conducted with the participation of the Egyptian Ministry of Health, the Population Council, the World Health Organization and the United Nations Population Fund.

A study published in the Egyptian Journal of Hospital Medicine tracked births at Banha Teaching Hospital: These amounted to 1500 cases in six months of 2018, 65% of the births were through Caesarean sections. Twenty percent of those born by a Caesarean section had complications that required placing them in incubators, and half of them had respiratory distress. This was followed by meconium aspiration; meconium is the first stool produced by an infant and consists of materials that were digested when the baby was still in its mother’s womb. Other cases included sepsis and neonatal jaundice. Newborns stayed in incubators between three hours and twelve days, and ten deaths were recorded.

Of the mothers who received any pregnancy care, there is a percentage that received regular pregnancy care and at least one Tetanus shot during their term with the last born who survived in the five years prior to the survey.

Of those born alive in the last five years prior to the survey, there is a percentage born through medical services and a percentage born through a Caesarean section, by their place of residence in terms of urban or rural settings in Egypt from 1988 to 2014.

Former Member of Parliament Fayez Barakat holds the Ministry of Health and the Egyptian Medical Syndicate responsible for the escalation of unjustified Caesarean sections newborn deliveries, and for the risks to which mothers and children are exposed since these are the two entities that should monitor the work of doctors. He noted that some doctors rush to perform a Cesarean section for profit purposes. As for his parliamentary request to commit doctors to writing a medical report to be submitted to a specialized panel before performing a Caesarean section, he says that, “Nothing has happened.”

The investigator repeatedly tried to communicate with the spokesperson at the Ministry of Health, Dr. Khaled Mujahed and then with Tariq Tawfiq, the Deputy Minister of Health for Population Affairs, but to no avail.

When she went to the Medical Syndicate to follow up on its procedures with doctors who perform medically unjustified Caesarean sections, Dr. Osama Abdel Hay, Secretary-General of the Syndicate and head of the Professional Ethics Committee, answered her, “No citizen has filed a complaint with the Syndicate because of medically unjustified Caesarean sections.” He blamed the women themselves and said, “It is a tragedy because sometimes women themselves request a Caesarean section.”

Abdel Hay was asked about the doctors’ responsibility to submit a medical report to explain the reason for resorting to a Caesarean section and presenting it to a specialized committee before the surgery and about the demand for a legislative amendment his response was, “The report on the Caesarean section should already be included in the patient’s file, but I am not sure of the rules followed in the women’s departments.”

Adam has recovered from his head wound, and Massa’s mother is working hard to remove the burn-like effects of injections from her daughter’s skin. Nada is calling on pregnant women to give birth naturally after a Cesarean section, and Marwa tries to treat the open wound left as a result of her Caesarean section. In the meantime, a medically unexplained Caesarean scalpel continues to hang over the bellies of hundreds of thousands of mothers and newborns annually.