SEOUL — Ahn Hyang Shim, 28, and her husband were filled with expectation as they entered Jinju Kaya Jamo Hospital on the outskirts of Pusan for the birth of their first child. They were told Ahn would need a caesarean because she hadn't produced enough water, but the doctor quickly reassured them that this was routine.
That was the last time Ahn's family saw her conscious. During the caesarean she fell into a coma, and she remains in a vegetative state more than nine months later.
"We found out later that low water levels are an excuse they often used," says Ahn Keun Yol, her grief-stricken father. "She's our only daughter. I can't tell you how it saddens our hearts to watch her lying there unconscious."
Proportionately, South Korea performs more caesareans than any other nation, with 43% of its babies entering the world under the knife, compared with 20% in the United States. Public health experts say many Koreans, awed by modern Western medicine, believe that caesarean deliveries are safer than natural births.
In fact, studies show that women who undergo caesarean operations are four times more likely to fall into a coma, face infection or mental stress or suffer other problems.
But more than simple misperception appears to be driving up the caesarean numbers. Until recently, doctors and hospitals earned three times more, or $1,490, for a caesarean birth than for a natural one. Add in longer hospital stays, and the fees jumped as high as $8,000.
"The major blame should go to the doctors," says Kim Ki Young, deputy research manager with South Korea's National Health Insurance Corp. "They're always urging women and frightening them in order to boost their fees."
Doctors, however, cite factors other than profit, including a legal system that absolves physicians of most liability in the case of caesarean births but leaves them vulnerable when accidents occur during natural ones.
Women often report being told weeks in advance that they will need a caesarean, even though medical literature suggests that the procedure should be a last resort generally decided on in the delivery room after signs of trouble appear.
Another factor in the incredibly high levels, public health officials say, is convenience. Doctors prefer to handle births during regular office hours rather than see their schedules upset by a long labor that lasts late into the night.
