Should you choose a Caesarean section?

Caesarean section has often been seen as a last option when it comes to child delivery. It is also seen as a lazy women’s choice for giving birth. However, even when it becomes necessary lack of preparation, not only due to negative disposition towards caesarean sections but also financially, results in avoidable fatalities. ADEREMI OGUNDARE presents an alternative viewpoint to this procedure and why it should be seen as an acceptable option for expectant mothers.

Recently, a video went viral on social media about a pregnant woman that didn’t make it alive because her husband could not provide the required deposit at the hospital for a Caesarean section which was the only option for a safe delivery. 

This was her second child and her spouse obviously was not adequately prepared financially for the eventuality of a Caesarean section.  

It was gathered that her first child was born through a vaginal delivery therefore the second should follow suit. However, recent happenings such as this one would indicate the need to consciously consider and prepare for both methods of delivery the moment a woman gets pregnant in order to prevent maternal deaths. 

Yet certain preconceived notions about Caesarean section that prevented people from considering this option warrants a fresh view of this method of bringing children into the world.

History of Caesarean section

According to Wikipedia, Caesarean section has been part of human culture since ancient times and there are tales in both Western and non-Western cultures of this procedure resulting in live mothers and offspring. According to Greek mythology, Apollo removed Asclepius, founder of the famous cult of religious medicine, from his mother’s abdomen. 

Numerous references to Caesarean section appear in ancient Hindu, Egyptian, Grecian, Roman, and other European folklore. Ancient Chinese etchings depict the procedure on apparently living women. The Mischnagoth and Talmud prohibited primogeniture when twins were born by caesarean section and waived the purification rituals for women delivered by surgery.

Yet, the early history of Caesarean section remains shrouded in myth and is of dubious accuracy. Even the origin of “caesarean” has apparently been distorted over time. It is commonly believed to be derived from the surgical birth of Julius Caesar, however this seems unlikely since his mother, Aurelia, is reputed to have lived to hear of her son’s invasion of Britain. At that time, the procedure was performed only when the mother was dead or dying, as an attempt to save the child for a state wishing to increase its population. Roman law under Caesar decreed that all women who were so fated by childbirth must be cut open; hence, caesarean. 

Other possible Latin origins include the verb “caedare,” meaning to cut, and the term “caesones” that was applied to infants born by postmortem operations. Ultimately, though, we cannot be sure of where or when the term Caesarean was derived. Until the 16th and 17th centuries the procedure was known as Caesarean operation. This began to change following the publication in 1598 of Jacques Guillimeau’s book on midwifery in which he introduced the term “section.” Increasingly thereafter “section” replaced “operation.”

Why a Caesarean section today?

Dr Gbolahan Obajimi, an associate professor (Reader) of Obstetrics and Gynaecology, at the University College Hospital (UCH), spoke with Nigerian Tribune on the importance of caesarean section and why it should be considered for pregnant women.

According to him, a Caesarean section is the surgical procedure used to deliver a woman who is unable to have a vaginal delivery. 

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He said, “Indications for Caesarean section vary. However, they can be grouped into recurrent or non-recurrent causes. The procedure can be performed either as an elective (planned) procedure or an emergent one.”

Dr Obajimi noted that reasons why women have caesarean section vary. “These reasons could be due to factors related to the mother alone, the baby alone or a combination of mother and baby. The goal of the procedure is to ensure delivery of a healthy baby to a live mother,” he said. 

Challenges of having a Caesarean section Speaking on the challenges of having a caesarean section, Dr Obajimi said, “These can be broadly classified into patient factor, health facility factor and manpower (skilled attendant) factor.” 

He explained that “A patient who refuses to consent for a Caesarean section when required is an important challenge related to educational attainment, exposure and sound judgement. 

“In facilities where appropriate instruments, gadgets and support services such as blood banking services are not available, deciding to have Caesarean section becomes difficult. 

“Importantly, where skilled manpower to perform the procedure is lacking, further aggravates this challenge of access to surgical delivery.”

Is there a limit to how many times a woman can have a caesarean section? Is it possible that after having a caesarean section a woman can still have vaginal delivery? Dr Obajimi responds: “Generally, after one Caesarean section in women who do not have a recurrent reason for caesarean delivery, an attempt can be made at vaginal delivery. If the vaginal delivery is successful, then the woman is categorised as one who has had a vaginal birth after a Caesarean (VBAC) and is subsequently permitted to have vaginal deliveries afterwards. 

“Once a woman has had two Caesarean sections, she will continue to have repeat caesarean sections due to the risk of spontaneous rupture of the uterus if subsequent labour is allowed to progress. 

“Four Caesarean deliveries are considered optimal and such women are encouraged to have permanent contraception such as tubal ligation. However, a few women, especially in the Middle East, have been known to have had up to seven Caesarean deliveries. This is the exception rather than the rule.”

Advantages and misconceptions

Speaking on the advantages of caesarean section, Dr Obajimi listed them to include avoidance of prolong labour in women at risk and ensuring good fetal outcome in potentially compromised obstetric scenarios.

However, there are some misconceptions that people have about a Caeserean section. 

“Misconceptions generally stem from the fear of having a surgical delivery to a wide range of myths and taboos suggesting that surgical delivery is an abomination and meant for weaklings,” he explained.

One widely held view about Caeserean section is that it is for lazy and unspiritual women. Speaking to this, the gynaecologist said, “It is not true. Caesarean section has nothing to do with strength or spirituality.”

Who should be a signatory during a Caeserean section? 

“The only signatory required for an adult above the age of 18 is the individual’s signature. The signature of the spouse is only required in special circumstances when the woman is incapacitated and mentally unable to make a rational decision,” Dr Obajimi explained. 

“The state can also authorise the procedure in dire emergencies to safeguard the lives of both mother and baby,” he added.

Giving their opinion on the matter of who can sign for a pregnant woman for her to have a caesarean section, Mrs Omolara Aina, a midwife, said: “If a woman is over 18 years of age, conscious and sane, she has the right to sign if her husband refuses to sign for the Caeserean section. Women should not be under bondage because of such an issue anymore.”

Mrs Folusho Oginni Liasu, a barrister, said “The woman can sign for herself if she is capable and stable to do so. In a situation where the woman is incapable, then her next of kin, who is often the husband, is to sign. 

“If the husband refuses, I believe the hospital can activate a rule or doctrine of necessity in emergency case to save a life and they must be ready to defend it in the court of law when such cases get to court. The court may consider their actions as a necessity to save a life.”

‘Not a trivial decision’

Concluding, in his counsel to pregnant women, husband, and relatives who have been advised to go for a Caesarean section, Dr Obajimi said, “The decision to have a caesarean section is not a trivial issue and patients alongside their families must be given full disclosure about the procedure, indications and the consequence of not having the procedure. All attempts must be made to ensure a healthy baby is delivered to a living mother.”