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My friend Jill sent me a link today.All women need to watch this.I’ve written about this almost three years ago. It’s happening in Malaysia. It’s happening in America.”We gynaes have lives too.” – my old gynae Dr Kim on why she thinks Cesarean is a good thing.Watch it. And let’s talk.

It’s happened again.

A friend of mine, a patient of Damansara Women’s Specialist Centre, was almost shoved into another C-section (this is her second pregnancy – her first was a pair of twins), had she not persevered against this dangerous trend towards elective surgery propogated by fear and driven by profit in private healthcare institutions.

Lia says she will be posting a detailed account of her experience soon, where she was pushed to go for a Cesarean only two hours after she was induced (the standard is six hours). Her gynae was the famous Dr Colin Lee, Medical Director of Damansara Fertility Centre and a Consultant, Obstetrician and Gynaecologist for the Damansara Women’s Specialist Centre.

For the uninitiated, a Cesarean is where the baby is delivered via an incision made in the mother’s abdomen and uterus. From personal experience, this is a painful, irreversible surgery that causes much inconvenience after birth and, I feel, contributes significantly towards a woman’s will to breastfeed post-partum simply because for a week, you cannot exert pressure on the wound and are advised to either be upright or lying down, positions which are difficult to breastfeed and will dissuade first-time mothers to persevere.

I had a Cesarean the first time I was pregnant, a horror story I have told countless times both on print and through word of mouth. The result of induced labour ten days before my due date, I was told that after my emergency Cesarean, the chances of me having a natural second birth would be forever compromised. On top of that, my bill comprising delivery, anaesthetics, hospital care for my baby and me, came up to almost RM10,000. I was there for three nights and Raeven five due to her jaundice.

To a lay person like me, the case for Elective Cesarean (where you choose to have a c-section instead of it being an emergency one) FOR THE DOCTOR is very logical.

Firstly, it is quick. One hour max, and you’re out, after prep. The doc gets to go and play golf in under two hours (these days obstretricians don’t even come in until delivery – the nurses and interns check you up and report to him via phone. I remember thinking it was pretty impersonal. After all, this is a life coming into the world. You may have witnessed countless of births but this is my first. I pay you almost RM500 for consultancy and you’re not even around? If you’re too busy, then perhaps you should take on less patients and give each one more attention.

Secondly, Cesarean pays. One surgery in a private hospital sets the patient back at least RM2,500. That is, only for the surgery itself. You haven’t included hospital stay, drugs, your baby’s care (whether or not she’s okay). The bill is normally above RM5K.

Thirdly, it is EASY to convince a patient to go for EC. It’s true that ANYTHING can happen in a natural birth. Yes, there are a lot of variables when it comes to a pregnancy and a healthy delivery. So are you telling me that the panacea for all these unknowns is surgery?

I was told that there is less risk in a C-section because the doctor is in control. I was told during my second pregnancy that the risk for me getting a rupture due to vaginal birth after Cesarean, without being induced, is 0.2 per cent. If induced, it goes up to 0.5 per cent. Negligible numbers but to a mother who doesn’t like to hear the word ‘risk’, and the words “My advice is to go for a C-section because then there’s no risk of a rupture”, which are clearly biased TOWARDS surgery instead of “Even a C-section has risks, but I’m just better at controlling them (unspoken: I’m more motivated to)”.

Other reasons include not having to WAIT for delivery, no pain because can use painkillers like epidural, a cleaner (as in literally cleaner, no need to clean up if you accidentally push out feces et al) delivery. Good for doctor, good for hospital, good for mother and baby, apparently. Does this mean doctors are advocating C-sections as the de-facto standard for deliveries in the future? Not officially, but it sure looks that way.

A blessing in disguise was my second daughter’s arrival two months early. Since I was in labour already, I was advised by my new, more conscientious gynae (who was also pro-C-section but he was at least honest about it) that it was better for me to check into UMMC (the old University Hospital) because they had the best neo-natal care there.

What I also pleasantly discovered was that the doctors and nurses at UMMC are very friendly and gave me top-notch care as well. Sure, the wards look horrid and the equipment are a tad old(-looking), but when you’re in pain, you don’t really care. I had a natural birth in the end and it cost me RM400. Skyler stayed at the neonatal ward for two months and her bill came up to only RM3,500.

To all first-time mothers out there: The need to know that you’re in the best hands, and the fear of pain and suffering, can be overwhelming, but do not make the mistake of equating private healthcare to the best healthcare there is. UMMC, being semi-privatised, is an excellent healthcare institution, and I’m not the only one who thinks so.

The benefits of C-section and its associated risks, are well documented. In fact, according to the American College of Obstetricians and Gynaecologists, “the jury is still out there on whether elective cesarean will become a standard of care or commonplace within the delivery room”. So why are our doctors gunning for it? And why are we allowing this to continue?

There used to be a time where we could trust our doctors to tell us what is best. They have all the information and give us our options based on this data. We relied on them to tell us the truth about our bodies because we did not go through eight years of medical school and training. Upon an oath, they have vowed to care for us in the best way possible.

These days, some of us, the connected few of us, are compelled to do our own research. We have to redefine what is ‘best’ because we cannot trust what we’ve been told.

If we can’t trust our healthcare providers, who can we trust?

Can the real doctors please stand up?

UPDATE: I’ve decided to post a letter from a Doctor Liew Li Lian, presumably a med intern in Singapore, who responded to my MSN Women article on my experience going through a Cesarean three years ago. This is what she says:

“Dear Blog (it escapes me why she addressed me as ‘dear blog’),

Came across an MSN writer from Malaysia today. Jennifer Tai. She was (I don’t know WHY she refers to me in the third-person. Perhaps her Emotional Detachment from Patients 101 learnings kicked in) writing about Caesarean sections. As in, her gynae duped her into having one for her firstborn, and subsequently she had another for her second.

Points:

1) It takes nine months to carry a baby to term. If with that time, you can still profess ignorance at your own healthcare decisions when the time comes, you are a real idiot (tsk, tsk – language language, dear doctor). Or mentally-challenged (like my man in his thirties who has been seeing a paediatrician for thalassaemia minor since babyhood, and yet is not bothered to ask what exactly it means to his quality of life).

2) ONE bad experience doesn’t mean the whole damn basket is rotten. Too many of the world’s problems are created by people making decisions based on bias from their own tainted experience. In fact, the bigger the decision (not personal ones, ones made for others eg advice columns) the more distance should be put between experience and fact. That’s why people don’t like scientists, because they make objective decisions.

Who does not like scientists? Are you just saying that because people don’t like doctors?You know very well this is NOT just ONE bad experience. You should start reading your medical journals, young lady. Many articles on the worrying increase of C-sections are widely available online).

The fact that she sounded like a case of gestational (pre-)diabetes didn’t seem to have entered into her first equation although she mentioned it in the second pregnancy. If she truly was in her first, it is an indication for more caution in bringing out her firstborn.

I did not have gestational diabetes during my first pregnancy. Yes, I got it during my second.

4) The “dearth of healers” mentioned in her article is not as simplistic a case as she thinks. Obviously again, she’s talking out of her arse, and hasn’t done her research.

(How complicated can an observation of a shortage in healers be? We are short of doctors, period. Wait a minute, you’re a Singaporean. What the hell do you know. Let me enlighten you.)

Another disappointment, for someone so well-read to be so assinine. I’d gladly show her the typical day of a medical student, junior doctor and hospital consultant, if she turns up. As well as an appointment with the medical equipment company on how much their gear costs. Perhaps after that, she’ll understand what the breakdown of actual costs are. And what percent can be absorbed by the hospital without bankrupting the system. And of course, the very real indications for caesarean sections, in which life and death are but a decision away.”

To Miss Lee, I ask you: Did you become a doctor to help people, or because your mother thought having a medical degree will make sure you’re a good catch for another rich man’s son? Or perhaps another doctor with his own private practice? Are you working for yourself, your hospital or for your patients? Are you in it to GET RICH?

Instead of sounding like a juvenile hopped up on an ego trip because you’ve a medical degree, perhaps you should re-evaluate your values and think about why you decided to become a doctor.

My ex-gynae once said to me “Gynaes are people too. We have lives and can’t be around 24 hours as people think we can.” I thought she was just being funny.

No, you’re not people. You’re doctors. You CHOSE to be doctors unless you went to the wrong classes and the wrong job for a few years and did not realise it, in which case you’re just a dumb-ass.

You knew what was at stake. And now just because you’re a specialist, you can stop being on-call? Stop caring? Work our deliveries around your schedule? Cut and go like we’re nothing but animals being literally being brought to a slaughter?

Then why are we paying you RM40 minimum per visit? RM480 for just coming in and telling us we should go for surgery?