By Lornet Turnbull, Seattle Times staff reporter, April 17, 2004
Area doctors have heard the grumblings among local Somalian mothers: They
fret that hospitals are using them to "practice" Caesarean sections — that
the rate for such surgeries within their population is far too high.
And from a culture where women can labor in childbirth for up to a week or
longer, Somalis say U.S. doctors are too quick to intervene, too quick to
Health-care providers at Harborview Medical Center, which is not a birthing
hospital but works with large numbers of immigrant women before and after
they give birth, have heard the complaints often — and dispute them.
They've organized a forum today to address the Somalian women's concerns and
a number of childbirth issues. In turn, they hope to learn more about
childbirth practices and customs within the Somalian culture.
The event, specifically for Somalian women, is from 2-4 p.m. in the Research
and Training Building at Harborview, 300 Ninth Ave.
That it is needed at all demonstrates how U.S. institutions are confronting
the cultural needs of this country's growing population of new immigrants.
"Frankly, their concerns worried us," said Blair Johnson, chief resident at
Harborview Women's Clinic, who is organizing the workshop. "We felt we were
giving good care to the community. We wanted to find a way to reach out to
Though Harborview officials didn't disclose the figures, Johnson said the
Washington state birth registry shows that among first-time mothers, the
C-section rate is higher for Somalis than any other group, although for all
Somalian mothers the incidence of C-sections is about the same as for
High rate of C-sections
The reason for the higher rate, Johnson said, is somewhat of a medical
mystery. Somalis' pregnancies tend to exceed their due dates — almost
without fail. That puts their babies at risk for fetal distress or even
death. It's a fact that has stumped local doctors.
"There's nothing that we know about the genetic makeup of this group that
explains this," said Dr. Susan Reed, an assistant professor in the
Department of Obstetrics and Gynecology at the University of Washington
School of Medicine.
Reed is also a physician at Harborview.
"The inductions we do for post dates (past-due-date births) are a very
challenging concept to get across to this population."
In the United States, according to the Centers for Disease Control and
Prevention, about one in four babies is born by C-section, up from 10.4
percent in 1975 and the highest rate since the government officially began
Elham Farah, a Somali who is trained in childbirth and works as an
interpreter, is not sure what the C-section rate is in her home country, but
she knows it's nowhere near as high as it is here.
On average, the surgeries are used in four of every 10 deliveries she
witnesses here, she said. "Sometimes for five deliveries, there would be
three C-sections," she said.
She said many Somalian women think having a C-section will reduce the number
of children they can have.
"Somali women here believe that doctors don't give them time to go into
labor," Farah said. "They don't listen to them but pay more attention to
what the computer is telling them.
"You have to understand many of them came from rural areas where they'd
never been to a hospital or a clinic," Farah said. "In Somalia, labor means
you walk around and wait. Here, you are confined to a bed, with all these
things hanging from you."
As a Somali with medical training, she finds herself in the middle: "I can
see the side the medical society is coming from," she said. "I also
understand where the Somali community is coming from. There's a clash and
that clash needs to be corrected."
Some thought unnecessary
Maryan Warsame, president of the Somali Women's Association in Columbus,
Ohio, home to the second-largest Somalian population in the United States
(after Minneapolis), said Somalis there also have a perception of
"We see Somali women who now refuse to go to the hospital when they're in
labor because they don't want doctors to induce — they don't want surgery,"
she said. "We need to educate the community not to be afraid to go to