Among the causes of maternal deaths are high blood pressure, haemorrhage and infections. US obstetrician-gynaecologist John Smith points out that even simply opening the abdomen, touching its contents, and closing it again will result in adhesions that can make bowel movements, urination and intercourse painful. Dr Sylvia de la Paz, consultant at the Fabella General Hospital, says most hospitals saw a sharp rise in CS operations after the introduction of the electronic fetal monitor. The same thing happened in the United States when the machine, which measures the baby's heart rate as well as womb contractions, was first used there. Normally, the baby's heart rate and the mother's contractions increase before birth and some obstetricians reading the monitor conclude that what they are seeing are signs of ''fetal distress'' and proceed to do a caesarean operation in what should be a normal delivery case.
Patients are often in no position to disagree with a doctor who suggests a caesarean.
Dr Mario Festin admits the figures for caesareans and hysterectomies done in the group's accredited hospitals are high. But he says this is partly because these institutions are usually chosen precisely for their expertise in gynaecological operations. But many doctors admit having abusive colleagues who put patients on the operating table out of sheer greed - and get away with it not only because there are little sanctions awaiting them, but also because most patients do not know any better.