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 induce.

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 them."

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 everyone else.

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 keeping track.

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 unnecessary C-sections.
"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 doctors."
 

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