With the baby by her side, Arlinda folded her little clothes into her suitcase – ready to go home.
At the Gynecology Clinic of the University Clinical Center of Kosovo (UCCK) in Pristina, she gave birth to her first child – weighing almost three kilograms.
It was a moment she had been waiting for and imagining throughout her pregnancy.
"Of course, I'm happy," she says, "but I still need some time to recover, because I was born by surgery."
The decision for a cesarean section came at the end of the process from her doctors.
Emotionally, she was not prepared.
"...but the doctors deemed it necessary and I agreed," says Arlinda, whose real identity is known to the Radio Free Europe editorial staff.
In bed next to her, on the morning of January 26, was Pranvera, another mother, with a similar story, but a different experience.
She had given birth to her first child naturally, but this time, the process took a different course.
"The pain started at home, in Lipjan. When I arrived at the hospital, they sent me to the delivery room. I stayed for almost two hours and was unable to give birth normally. They told me I needed surgery," Pranvera recounts, adding that, apart from the baby's water breaking, no other reason was explained to her.
Two women, two births, two personal stories. But both reflect the same health reality in Kosovo: the significant increase in cesarean births.
Their peak was reached in 2024, when almost half of births in the country were performed by cesarean section.
But, according to data from the National Institute of Public Health of Kosovo, this trend is not the same in all institutions: in 2024, private hospitals dominated in terms of the number of cesarean births.
The World Health Organization (WHO) defines cesarean section as a surgical intervention used to save the lives of mothers and babies when complications make natural birth dangerous.
While it is beneficial when there are clear medical reasons, the WHO warns against the unnecessary use of cesarean section, stressing that it "should only be performed when it is truly necessary to avoid risks to the mother or baby."
According to studies, unnecessary or excessive use of cesarean sections can increase the risk of post-operative complications, infections, and subsequent obstetric problems for women.
Fear of responsibility
At the Obstetrics and Gynecology Clinic of UCCK, during 2025, over 7 thousand births were performed, of which 3.074 were by cesarean section.
The clinic's director, Zef Ndrejaj, says that doctors often face difficult dilemmas.
"There are cases when doctors fear that if they insist on a natural birth and it becomes complicated at the last moment, they could face serious consequences," Ndrejaj tells Radio Free Europe.
According to him, surgery should not be the first option, but often becomes so due to the lack of clear protocols.
He adds that the clinic also treats serious and urgent cases referred from all over Kosovo – which also affects the statistics.
"The patient's wishes are being respected"
The Association of Obstetricians and Gynecologists of Kosovo confirms the increase in cesarean births.
Its chairman, Naser Rafuna, says that an important factor in this trend is the demand from women themselves.
"The new generations are very interested in surgical birth. The patient's wishes are being respected, to be honest," he says, adding that pressure from family members and fear of complications from normal birth are pushing gynecologists to withdraw.
But gynecologist Arbër Lila, who works at the Gjakova hospital, emphasizes that the responsibility for the increase in cesarean births does not fall solely on mothers.
"We, as professionals, also have that part of our 'contribution' to such a large increase in cesarean births," he says.
According to Lila, the lack of communication and explanation of the birth process, as well as the fear of lawsuits, directly affect doctors' decision-making.
"Normal birth requires time, vigilance and great responsibility. Whereas cesarean section is performed faster and often creates a feeling of 'relief' for everyone," he tells Radio Free Europe.
Lila adds that this phenomenon is not specific to Kosovo.
"It's a trend in all countries. The figures are almost alarming - the situation is approaching a parity between normal and caesarean births," he declares.
World trend
According to the World Health Organization, cesarean section is among the most common abdominal surgical interventions in the world, with a continuous global increase – from 6% of births in 1990 to 21% in 2018, and is expected to reach around 30% by 2030.
Projections show that 38 million women will give birth by cesarean section in 2030, and 88% of these operations will occur in low- and middle-income countries.
A roadmap exists, but implementation is lacking
In July 2025, the Kosovo Ministry of Health approved the clinical guideline for the management of cesarean births, with the aim of enabling women to make informed decisions based on scientific evidence.
The document emphasizes that women must be informed about the short-term and long-term consequences of this procedure and that this right is guaranteed by law.
But, even though it has entered into force, the guideline continues to be unimplemented, due to the fact that it has not been fully integrated into the daily work of health institutions.
The reasons are also related to the lack of oversight mechanisms.
The Kosovo Clinical and University Hospital Service Board, which oversees UCCK and regional hospitals, has requested several times that the number of cesarean births be reduced to a minimum, and that informational notices be placed in each room for patients regarding this procedure.
"Where we have conditions for normal birth, there should be no possibility for other births," concludes the director of the Gynecology Clinic, Zef Ndrejaj. /REL/
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