More Indonesian Women Are Getting C-Sections Than Ever Before

It was the busiest Wednesday of his 20-year career as an OB/GYN. Since the crack of dawn Dr. Deddy Meizia was performing back-to-back surgeries at three different hospitals in Cimahi, West Java.

This day happened to be one of the busiest not only for Dr. Deddy but also for many other OB/GYNs around the country. The date was December, 12 2012. On this day Dr. Deddy helped twelve women give birth. The mothers wanted their child to have a 'pretty' birthday made up of the number 12, but some were not able to induce birth, so in order to reach the deadline, they chose to have a cesarean section, or C-section.

"It was a pretty date, the 12-12-2012. Out of twelve patients, 10 had to undergo cesarean section," Deddy told VICE Indonesia.

Although it was a busy day, Deddy said it wasn't tricky performing back-to-back C-section surgeries, because the procedure isn't that complicated. "I'm used to it. One caesarean section would usually take half an hour, depending on the skills and techniques of the doctor," he said.

The two most popular methods of childbirth are vaginal delivery, sometimes called vaginal breech or "natural birth," and the other is cesarean section or C-section. Usually, C-sections are recommended when the mother, baby or both have medical conditions which would require a C-section or if the the mother's hips are too narrow for the baby to pass through.

"We perform C-sections when there are problems with the pregnancy. Some patients with medical conditions want to minimize the health risks of childbirth," said Deddy.

In Indonesia, C-sections are starting to make the jump from medical necessity to preferred delivery method from many pregnant women. The trend has grown, especially in order for the babies to be born on dates that are considered lucky or special.

According to the government, C-sections are performed in about 15.3 percent of all births in Indonesia. The trend is regional as well, a survey of nine hospitals around Southeast Asia found that 27 percent of all births were done through C-section.

The trend has been moving towards C-sections for decades. Between 1990 and 2014, births in Asia bt C-sections jumped from 4.4 percent to 19.5 percent of all births. The rise in popularity of birth by C-section might even be affecting evolution.

In Indonesia, several hospitals offer packages or promotions to entice mothers to chose C-sections. VICE Indonesia found that a private hospital in Tangerang, a satellite city of Jakarta, offered a discount on C-sections for women who have medical need for one. The discount is not the only "advantage" that the hospital management was offering.

We called a private hospital in Jakarta to inquire about their C-section specials. "There are packages," they said. A private hospital like this usually partners up with a bank to offer credit programs to help cover the cost of a C-section.

Mildri Putri Fudradjat chose to deliver by C-section when she had her first daughter. When pregnant with her first child in 2013, she chose to undergo C-section almost as soon as she started planning her childbirth. Although her doctor said that it was be possible for her to deliver vaginally, she insisted on getting a C-section.

"I was scared to die. If I died, nobody would take care of my daughter," Mildri told VICE Indonesia. She said she had made up her mind when she read an article on how painful childbirth can be. "I read an article which said human bodies can only go through pain equal to 42 broken bones. Meanwhile, the pain of childbirth is equal to 54-60 broken bones."

There are many medical pros and cons to vaginal and C-section childbirth, but mothers like Mildri who have C-sections are often arbitrarily judged for choosing how they want to give birth. "Even a couple of doctors said before I gave birth in the operating room, 'You're a wimp' for refusing vaginal delivery.' Meanwhile those who go through C-section experience a lot of pain afterwards," she said.

"I was traumatized, I had baby blues until my child was seven months old. It's not a walk in the park for mother to go through a C-section. We face more pressures and stigma than those who had a vaginal delivery. Women who had their baby delivered vaginally aren't shamed by others" said Mildri.

The growing number of C-sections can be attributed to more pregnant women choosing to give birth his way, even though vaginal childbirth has actually become less dangerous. But Dr. Deddy said he has no right to refuse the choice of a pregnant woman to undergo C-section.

"We explain to patients the risk of C-section. If that's what they want and they're prepared for the risk, then it now depends on the medical preparation—if the doctor is ready."

C-section are a costly option. In public hospitals, patients have to pay Rp 8-15 million ($600-1,100 USD). In private hospitals, the 'VIP class' option can cost more than Rp 50 million ($3,700 USD). Deddy believes part of what's driving the popularity of C-sections is that Indonesia's public healthcare system, BPJS, now covers C-sections.

"There's a rise in the demand of C-sections. I noticed because I have a lot of patients using BPJS," said Deddy. "Now patients from the middle and lower class have access to C-sections, so they want to try out the option. They now have the same rights, especially in public hospitals. It's all free."

The World Health Organization has said that national C-section rates shouldn't go above 10-15 percent. It estimated that there are 3.18 million C-sections worldwide because of medical reasons, and almost twice as many, 6.20 million, are C-sections by choice. According to the WHO, countries with more than 15 percent or higher rates of C-sections are categorized as "overused," which means most Southeast Asian countries fall into this category.

Although today, C-sections are more accessible, it doesn't attract all prospective mothers. Dr. Dhita Dewi Alviane, a doctor in her last trimester, doesn't plan to have a C-section. "From the beginning I chose vaginal delivery, because naturally the women's bodies are prepared and equipped to give vaginal birth."

Although she plans on doing vaginal delivery, Dhita disapproves of any judgments or stereotypes against mothers who chose C-sections. "The principle of today's medical practices is patients can decide the medical treatments they want to go through, and they also have the right to refuse," said Dhita. "In the case of C-sections, patients have the right to choose to undergo C-sections, but of course they have to accept all the medical advantages and risks."