The joy of every woman is to deliver
her baby normally. This is in spite of
the many travails associated with
pregnancy and delivery. Before now,
the most available or preferred
option for most women is natural birth. As the world recorded
countless maternal deaths due to this
process, scientists sought an
alternative and came up with the
Caesarean Section, CS. Today, many babies have been
delivered successfully through this
process. But this success story is not
without criticisms. In fact, this life-
saving option has become a subject
of controversy. How be it, a good number of women now claim CS is
now an option explored by doctors
to extort huge delivery bills. Chioma Obinna, Features Writer (Health) reports. THE fears and myths: EVELYN Obi, a
28-year-old mother of two, did not
bargain for a CS. According to her,
having a baby through CS was part
of her dream. ”It is unthinkable.
When I was pregnant, there was no sign that anything was wrong with
the position of the baby. I was only
told the day labour began that I was
to have a CS. When I asked why, I
was told my baby was not lying
properly. “I was devastated because I had my
antenatal services in the same
hospital. I could not tell any of my
friends. To make matter worse, my
husband could not afford the
required cost of surgery. The hospital did not leave us with any
choice. We were ready to borrow
even from our enemies.” Asked why she described it as an
unthinkable venture, Evelyn said:
“Where I come from, having babies
outside the natural way is a taboo.
You don’t talk about it. Such women
are considered weaklings. We later went to another hospital where I
had a normal delivery.”
Evelyn is not alone, Mrs. Ifeoma
Agwu, a mother of two, also
exploded when asked if she would
opt for a CS over the natural
delivery process. “If I had known
that some hospitals are now making CS a business venture, I would have
inquired from another hospital
before settling for it. “I must not deny the fact that CS is
important in child delivery but not in
all cases. When I was pregnant for
my second child, I was advised to
have a CS since my first child was
through CS but I refused. At that point, a friend of mine introduced me
to a midwife who delivered me of
my baby without complications.” Ifeoma who was apprehensive over
the alarming rate of CS among
Nigerian women said: “I think CS has
become brisk business for medical
doctors in Nigeria”. But for six-month pregnant Mrs. Ope
Ige,the story is different as she
preferred to have all her children
through CS rather than suffer the
pains that come with natural
delivery. According to her: “I have three
children through CS and I don’t think
I can bear the pains of pushing a
baby. I see it as a suicide mission”. There is an alarm in the reproductive
health circle. Investigations have
shown that CS has taken over.
Available reports have shown that
having babies through the natural
process is on the decline. Within the African setting, having
babies through the natural process is
seen as a show of strength. So, when
a woman cannot do so, she is seen as
a weakling. Her friends mock her as
a result, members of the family keep mute over the matter. In fact, such is
the secrecy, it is rated as a mortal sin.
Today, however, thanks to
technology, all that has changed but
not without the controversy CS is
beginning to generate. Caesarean section or delivery also
known as C-section is a birth through
an incision in the abdominal wall
(laparotomy) and uterus
(hysterotomy) rather than through
the vagina. CS is performed whenever abnormal conditions
complicate labour and vaginal
delivery, threatening the life or
health of the mother, the baby or
both. Doctors basically recommend
CS when an expectant mother is experiencing a difficult labour. Caesarean delivery According to the Centers for Disease
Control and Prevention, CDC, there
has been a gradual increase in
caesarean births over the past 30
years. In November of 2005, the
Centers for Disease Control and Prevention, CDC, reported the
national caesarean birth rate was the
highest ever at 29.1 percent in the
United States, which is over a quarter
of all deliveries. This means that
more than one in four women are likely to experience a cesarean
delivery. But the World Health
Organisation, WHO, has stated that
the caesarean rate higher than 10-15
percent is unnecessary regardless of
location. In Nigeria, also a study carried out on
Caesarean Section in a secondary
health hospital in Awka, by the
Department of Obstetrics and
Gynaecology, Amaku General
Hospital, Awka, Anambra State by LC Ikeako1 and colleagues in 2009
showed a gradual yearly increase in
rate from 9.0 percent in 2005 to 11.4
percent in 2009. Maternal mortality
rate was 480 per 100,000 deliveries,
while the prenatal mortality rate was 63.8 per 1000 total births. Vanguard Features, VF, learnt that
apart from difficult labour, doctors
often advise mothers who have had
previous C-section to have it again.
This action has made many women
wary of the technology. Most of the women are of the view that enough
options are not being given to them
by the doctors. Apparently due to the demonisation
of CS in the country, some of the
women who responded to VF also
expressed worry on the way and
manner some medical doctors handle
issues regarding CS in the country. Others are of the opinion that they
were not well counseled on why
they should under go a C-section.
Still, some alleged that many of the
doctors are usually in a hurry to have
it done. VF investigations reveal that many
pregnant women would not even
give the caesarean section option a
thought during delivery. Some told
VF that they would prefer to go
through labour pains that come with natural delivery and forget about it
once their baby is delivered than go
through weeks of recovery that
comes with caesarean section. Rita Eke said: “My mother gave birth
naturally and that has been our
culture. She did not experience any
problem during her child-bearing
years. These things are better done
abroad where there are facilities. Have you forgotten the environment
we are in? Electricity supply is not
constant and there is also the fear of
infection. No woman should gamble
with her life. I refused to risk my life.
I will have my babies like my parents did.” But many like Jane Ojo, however, is
of the opinion that: “If my younger
sister, Grace, had listened to her
doctor’s advice for a C- Section when
it was discovered that her pelvis was
too narrow to have a safe vaginal delivery, she would still have been
alive today. But she bluntly refused,
insisting that she would have her
baby through vaginal delivery. “Despite the pressure mounted on
her by the hospital where she
registered she refused. She went to
another hospital and was allowed to
have her way. In the process of
having the baby she died.” Another mother of three, Juliana
Jones, said: “I could have been a
proud mother of four children today
if I had accepted to have my first
baby through CS. After two days, of
agonising labour without success, I was wheeled into the labour room
for CS but then, it was too late to
save the baby but a narrow escape
for me. I’m alive but the baby did not
make it”. The facts: Dismissing insinuations on
the safety of CS, he said: “Caesarian
section is very safe if it is done in the
right place by the right person and
with right infrastructure in place.” Also acknowledging the fears
expressed by some of the women, he
said: “The fears of the women are
real because it is safer to have your
baby naturally than a C-section,
especially in a country where the infrastructure is not controlled.
Maternal mortality is very high in
Nigeria and there are many reasons
for that and one of the reasons is
that we don’t have clear bench
marks for the facilities that provide emergency obstetric care. Emergency obstetric care “There should be a clear bench mark
which says before you can deliver a
baby in this facility you must have
this kind of infrastructure in place. So
if we have that kind of infrastructure
in place, I think we would allay the anxiety of some of these women.
Anybody can have a room and say I
am doing a CS. Until we have that
kind of control we will continue to
lose women.” Also a surgeon with the Lagos State
University Teaching Hospital, LASUTH,
Dr. Olugbenga Saliu Oseni, described
CS as an interventional delivery
process whereby you have
complicated delivery. According to him, it is sometimes the only option
left to save the life of mother and
child. On situations that could warrant CS,
he said: “The best thing to happen to
a woman is to have a normal
delivery but when this is not
available, the preferred option
should be CS because you can evaluate your result”. According to him: “There are many
reasons why a doctor should
prescribe CS and some occur in critical
situations. Others are used to prevent
critical situations and some are
elective. CS can occur when placenta lies low in the uterus and partially or
completely covers the cervix. One in
every 200 pregnant women will
experience placenta previa during
their third trimester. “Again, placenta abruption could also
cause a doctor to prescribe CS. It is
the separation of the placenta from
the uterine lining that usually occurs
in the third trimester. Approximately
one percent of all pregnant women will experience placenta abruption.
In approximately one in every 1,500
births, the uterus tears during
pregnancy or labour. This can lead to haemorrhaging in
the mother and interfere with the
baby’s oxygen supply. This is a
reason for immediate caesarean. The
position of the baby could also lead
to CS. When dealing with a breech baby, a caesarean delivery is often
the only option, although a vaginal
delivery can be done under certain
circumstances. “Also, cord pro lapse is another
cause; it occurs when the umbilical
cord slips through the cervix and
protrude from the vagina before the
baby is born. When the uterus
contracts, it causes pressure on the umbilical cord which diminishes the
blood flow to the baby. Sometimes,
we do have women who are small in
stature or are in the border line. It is
obvious such women can go through
normal delivery. Fetal distress “Another reason is fetal distress. If
fetal monitoring detects a problem
with the amount of oxygen that the
baby is receiving, then an emergency
caesarean may be performed; failure
to progress in labour: this can occur when the cervix has not dilated
completely, labour has slowed down
or stopped, or the baby is not in an
optimal delivery position. Ninety percent of women who have
had a caesarean are candidates for a
vaginal birth after caesarean for their
next birth. Cephalo pelvic
disproportion, active genital herpes,
diabetes increase chances of caesarean as well as pre-eclampsia,
that is high blood pressure in
pregnancy, birth defects and multiple
births amongst others,” he added. Dismissing beliefs that doctors are
recommending CS in order to make
more money from patients, Oseni
said: “It will be crazy for any doctor
to think he wants to do CS because
he wants to make more money; that means that person is not an expert. I
know that when I want to do
surgery I lose appetite. You can still
collect the same amount for CS for
normal delivery because there are
some normal deliveries that are even worse than CS. So that is an idea
people do have in their head. CS is an emergency when you did not
expect it and you need to intervene
urgently. It is elective when you
know that the baby must come
through CS. For instance, an elderly
person who has suffered infertility for a long time and is having a baby
for the first time; we call such babies
‘precious baby’ and we don’t want
anything to happen to them. So you
want to electively deliver them by
CS. Hypertension or pre-eclampsia Elective CS is safer than emergency CS
because everything is okay when
you do elective. But in case of
emergency, the patient may have
some other abnormalities like
hypertension or pre-eclampsia. Sometimes we deliver them if they
are progressing well. Hardly will one
die because of an operation. Death
arises from either the patient and
relatives.” He explained that from experience
many of the patients who were
advised to have CS and they refused
and ran away from the hospital
usually come back to the hospital
with more complicated cases such as inability to conceive again, loss of
child, amongst others. Oseni argued that studies have
shown that some babies delivered
by Caesarean Section have a better IQ
because they did not go through
stress of delivery.
www.vanguardngr.com/2013/05/controversy-caesarian-section-the-rule-or-option/

It's truly the joy of most women to deliver their babies via normal delivery.

I have tasted both worlds; normal and CS. If I have to make a choice again it will be normal delivery because I would rather go through labour pains for a few hours, have the baby and be free to carry out any activity I so desire afterwards than to go through the after pains of CS where you have to be very cautious of everything you do till you heal. The afterpain to me is not worth it.

From my point of view, its better to go through the pains and see the result (baby) than have the baby and start feeling pains. However, if there are health risks involved, then its not a shame to go through CS to ensure that both mother and child are fine.

On point tiptess. I've had both deliveries and I would go for the natural delivery anytime. I'd rather chooe the pains of the moment than to be restrained and in pains for weeks to come. But what baffles me is the way our people condemn the c-section option. When I had my son via cs, MIL was telling not to tell anybody as if its a thing of shame (me I told people o). That's why some people run away from the c-section option even if that's guarantees the survival of mother and babies. In the name of trying to avoid cs, I've heard cases on maternal death, infant death and both. May God give our people wisdom. Hospitals should also not be tricking patients to do cs unless its the last option or the mother opted for it.