Tygerberg hospital faces Caesarean section backlog crisis

Head of the Western Cape Health Department Keith Cloete. (Photo: Nasief Manie)

16 Oct 2024

An insider at Tygerberg Hospital who elected to remain anonymous described ‘chaos’ in the maternity ward in recent weeks, with a significant backlog of pregnant mothers awaiting elective C-sections.

In recent weeks, Tygerberg Hospital in Cape Town, Western Cape, has faced a challenging backlog of patients waiting for elective caesarean sections (C-sections), a surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.

In October, an insider at the hospital who elected to remain anonymous told Daily Maverick that the backlog for the procedure was about double what it had been previously, with about 30 women awaiting surgery. They stated that while the backlog was not new, it had worsened.

tygerberg hospital c-sections Tygerberg Hospital, Western Cape. (Photo: Ashraf Hendricks)

“It’s chaos in Tygerberg’s maternity ward,” they claimed.

“It’s the numbers [of patients] picking up, but the consultants, the doctors are also fewer because of the budget cuts. And theatre times – even though there are enough theatres, there’s just no people. There were a lot of nurses who resigned from theatre because of the constant pressure.”

Aside from budget cuts and reductions in staff, another factor the insider linked to the increased backlog was a higher patient load. They claimed some individuals were coming into the Western Cape from other regions to seek more reliable medical care.

“It’s like a feeling that you get – the patient load is just dramatically picking up, all of a sudden… It has been for a while now, say a year or two, but it’s unbearable,” they said.

Long-standing issue

Prof Stefan Gebhardt, head of the Department of General Specialist Services (Obstetrics and Gynaecology) at Tygerberg Hospital, confirmed that the facility had seen a “challenging backlog” of patients for elective C-sections over the past few weeks, with up to 30 women awaiting procedures.

However, he said that the backlog had been a “long-standing issue since 2009”.

“Despite our best efforts and improvements over the years, we remain with the challenge but are committed to addressing each case with the attention it deserves,” said Gebhardt.

He said that the hospital had 14 patients scheduled for elective C-sections on 11 October, and that the first 10 cases were surgeries that could not be attended to earlier that week.

Elective C-sections, he noted, were planned surgical procedures performed when there were non-emergency medical reasons or specific maternal preferences that made a caesarean section the safest option.

“While these procedures are important for ensuring maternal and foetal health, they are scheduled around more urgent, emergency and high-risk cases, which are prioritised due to limited resources and theatre time. As a result, elective C-sections may experience delays, particularly when the demand for emergency or complex cases is high,” he said.

“The public health system strives to balance the need for planned surgeries while ensuring that the most critical and life-threatening situations are attended to promptly.”

The insider at the hospital who spoke to Daily Maverick anonymously said that there had been instances in which patients whose elective C-sections were delayed experienced adverse health outcomes, including two cases this year in which the women allegedly went into labour and suffered uterine ruptures, and one in which a woman died due to preeclampsia.

“There’s sometimes scar tissue on the uterus because of the previous C-section and then it can literally burst if you wait too long,” they said.

Gebhardt said that the hospital was unable to comment on individual cases, but noted that they were “deeply saddened” by any case in which prolonged waiting times resulted in adverse outcomes.

“...we take these incidents very seriously. We have systems in place to report such cases to hospital and provincial managers, as well as the medico-legal office, in line with our commitment to transparency and quality of care. We continuously strive to provide the safest care possible within the constraints we face,” he said.

Gebhardt told Daily Maverick there hadn’t been an increase in the maternal death rate at Tygerberg Hospital in recent years.

“Maternal deaths are always a serious concern, and each case undergoes thorough review by both internal and external experts. The data is reported to the National Department of Health and detailed findings are published in the Saving Mothers reports,” he said.

“Tygerberg’s average number of maternal deaths has consistently ranged between 14 and 20 per year, and this has remained the case in 2024. The only exception was during the Covid-19 period, where we, like many others, faced a significant increase due to the disease.”

Complexities and delays

According to Gebhardt, while the number of pregnant women being referred to Tygerberg’s Obstetrics and Gynaecology Department has not increased, the complexity of the cases they see has.

“Many of these women require specialised and urgent care that Tygerberg, as the only level 2/3 hospital in the eastern half of Cape Town, is equipped to provide. We have one theatre running 24/7 and additional weekday lists, but any unforeseen circumstances, such as complex cases taking more time than expected, can result in delays,” he said.

All doctor positions in the Obstetrics and Gynaecology Department had remained filled this year, continued Gebhardt. However, he described specialised nursing and anaesthetic support as “a precious and limited resource”.

“We continue to prioritise the urgent and emergency cases where this expertise is most needed, ensuring every patient receives the safest and most appropriate care possible,” he said.

“In O&G, there has been a reduction in theatre time over the years, specifically affecting gynaecological surgeries rather than obstetrics. We acknowledge the extended waiting times, such as over a year for fertility surgeries or over six months for hysterectomies. We understand how challenging this is for our patients, and we are constantly striving to manage these cases compassionately and efficiently.”

“Cancer surgeries are also under pressure, and we work tirelessly to ensure that every patient receives the necessary care, even if there are delays. This is a challenge faced by other hospitals as well, but we remain dedicated to minimising any impact on patient outcomes.”

Health funding crisis

Reports of the increased backlog for elective C-sections at Tygerberg Hospital have emerged against the backdrop of a broader health funding crisis in the Western Cape and South Africa.

tygerberg hospital c-sections Western Cape Health Department head Keith Cloete. (Photo: Nasief Manie)

Head of the Western Cape Health Department Dr Keith Cloete told Daily Maverick there was a “significant shock” to public healthcare financing in the country during the 2023/24 financial year. A major factor behind this was a national government commitment to a higher-than-expected wage increase for public servants, which ended up being only 78% funded.

In the Western Cape, there was also a reduction in the Provincial Equitable Share for the province, which is the funding from the nationally collected tax revenue, allocated by the National Treasury for the provision of healthcare, education and social development services, among other needs.

“Those two things together with the fact that the actual annual increase for public health spending has been stagnant for many years, and it was not keeping up with the inflationary pressure every year, all came together in 2023/24,” said Cloete.

The resultant shortfall of almost R1-billion in health funding in the Western Cape meant that the provincial Department of Health and Wellness was unable to fill all vacant posts in the public health system towards the end of last year, he continued.

According to Cloete, the budget cuts have resulted in rising backlogs, not only for surgeries linked to obstetrics and gynaecology, but all elective surgeries.

“Post-Covid, we almost got rid of all of our backlog, and the backlog has now escalated again, almost to the same levels... All the gains we’ve made have almost been undone because of this financial situation. And that’s [not just] for obstetrics and gynaecology,” he said.

Cloete said that with the “acute assault” on the health budget, any strategies to address the impacts could take about three to five years to get the system to a point of recovery.

“We can now say we’ve almost hit the bottom of this impact and we need to start building forward, but it’s going to take us about three or four years to recover from that, and if the budget situation does not improve, you go into a downward spiral,” he said.

“We now need to make the case to say, we cannot sustain where we are now… We have to start… employing more staff, getting the right people into the system and slowly starting to make gains, which we are starting to do because we are now in a position where we can start filling posts again.

“That’s the pressure we’re currently trying to exert on Provincial Treasury but mostly National Treasury, because we now need to be in a position to be able to build our system up again the way it was pre-Covid.” DM

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Maverick Citizen

Long-standing issue

Complexities and delays

Health funding crisis