Sunday, July 29, 2012

Motherhood: Caesarean section by choice

Once the delivery option of last resort, caesarean sections are now gaining popularity among expectant mothers.
A Caesarean Section is a medical surgery to deliver a baby and it involves making an incision in (cutting open) the lower part of the woman's tummy to deliver her baby in a situation where the mother cannot have normal, vaginal childbirth.
“If the mother's health is not stable, the vagina is too small for the baby to pass through or if the
baby is positioned wrongly and there are signs of distress in the baby, then a caesarean section
might be
necessary,” says Mrs. Moridi Lola Fagboya, a medical practitioner at the Lagos State University Teaching Hospital's (LASUTH) Obstetrics and Gynaecology department.
Although a caesarean section (C-section or CS) is known to save lives in the event that complications occur, as demands on modern women grow, fewer mothers-to-be appear to have the time or willingness to attend natural-childbirth classes and many request a C-section even without a medical reason.
Certain mothers and physicians now choose surgery just to minimize stretch marks and saggy loose skin. Others schedule caesareans three or four weeks before their due date, to ensure the timing of the birth is convenient.
Mrs Ronke Oyorhigho, a mother of three, has never had to undergo a surgical procedure but says she would rather have a caesarean section than a normal delivery, “I do not see any big deal in CS. With my last baby, I specifically asked the doctor for a caesarean section but my doctor refused because of my health condition.”
Stating why she opted for surgery, she said, “I chose CS because I had some delay in my delivery date. I was already over forty weeks into my pregnancy and the baby was not coming. So I felt it would be better if I go for a CS because it is more convenient.
“I do not see any big risk in CS because going into the labour room is a risk on its own, so CS is not a big deal. I have friends who have gone through CS and they all keep saying that if they were to have more babies, it would be through CS,” she finished.
While supporters believe that surgery eliminates the rare but terrifying complications of vaginal delivery that result in birth injuries or even a baby's death, those who favour normal birth processes decry the lengthy recuperation and the increased health challenges during subsequent pregnancies as a result of previous surgeries.

According to the World Health Organisation, no country can justify having a caesarean section rate greater than 10 to 15 per cent but Nigeria seems to be on a mission to beat this record.
From a financial stand point, reports indicate that that the higher costs of pregnancy related surgeries cause doctors to recommend caesarean sections to their patients. Also, the preference towards favouring surgery could be decreasing the level of professionalism among medical personnel.
Giving insight, Dr. Micheal Erojumo explains, "Obstetricians are not as good at managing vaginal births as they used to be. It is a lot easier for them to take a baby out through an incision than manoeuvre the child through the vagina. Almost all the breech babies are now delivered through CS where as, there are other ways of properly delivering that baby.
“Things that would have been done with a forceps 20 years ago would now be a serious emergency case simply because the doctors are not well-trained and many of them are greedy and want to mark up the hospital bills."
With the increasing clamour for an easier method of child birth, many may ask 'what is the harm in choosing a caesarean section?'
For one thing, experts say, C-sections mean a longer hospital stay and weeks of recuperation. Babies born by caesarean section are also twice as likely as those born naturally to become obese or sickly and mothers may develop complications in future.

A Resident Doctor, Patrick Udeh, states, “There is a worrisome likelihood that during future pregnancies the woman could have a condition called placenta previa, where the placenta blocks the cervix or a ruptured uterus, increasing the possibility of the baby dying in the stomach.”
Continuing, he says the surgery also carries a slightly elevated risk of death for the mother because of complications from anaesthesia, infections, and blood clots. And scar tissue that forms at the incision site can lead to bowel obstructions years or decades later.

The risks of caesarean section

MOST mothers and babies do well after a C-section. But it is a major surgery, so it carries more risk than a normal vaginal delivery. It also takes longer to recover from a C-section than from vaginal birth.  After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth later. If the woman gets pregnant again, there is an increased risk of the scar tearing open during labour. Other possible risks of C-section include:

•Infection of the incision or the uterus.
•Heavy blood loss.
•Blood clots in the mother's legs or lungs.
•Injury to the mother or baby.
•Problems from the anaesthesia, such as nausea, vomiting, and severe headache.
•Breathing problems in the baby if it was delivered before its due date.

Most women go home 3 to 5 days after a surgery but it may take 4 weeks or longer to fully recover. In contrast, women who deliver vaginally usually go home in a day or two and are back to their normal activities in 1 to 2 weeks.

-Rita Ohai/The Nation

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