Why some women are opting for Caesarean section

FOR women with a complicated pregnancy, a caesarean section (C-section) may be necessary for the health of the mother, child, or both.

However, for a variety of reasons, some women choose to have their babies by a ‘planned’ or ‘intended’ caesarean section even when there is no medical need to do so.

Take Adenike Mohammed, for example, when she was expecting her first child three years ago, she made the decision to have a caesarean section because she wanted to avoid the agonising pains that come with natural birth.

“Pregnancy itself was hard and I couldn’t bring myself to endure more suffering during delivery. So, I chose to have my baby through a C-section because medical science had improved greatly. Before the naming ceremony on the seventh day, I would have been discharged from the hospital,” she says.

Mrs Toke Hammed’s request for a C-section was for cosmetic reasons. Aside from her fear of a long labour period, she wanted C-section so that her doctor, after bringing out the baby, can trim all the fat in her stomach to ensure that it is flat.

For Mrs Ekaete David, who was preparing to have her fourth baby, she accepted to have CS based on health grounds; for her safety and that of her unborn baby. She was told that her baby was too big.

“Complications are higher as the number of pregnancy increases. In my case, it was my fourth pregnancy and the doctor kept telling me my baby was too big. I became afraid and asked if I could do CS. It is better rather than suffering and eventually going through CS,” she said.

Today, more and more women are opting for C-section deliveries, and though the reasons vary from one woman to another as many have expressed fear of unbearable labour pains, birth canal getting out of shape, as well as other social and cosmetic reasons.

A number of theories exist as to why a preference for C-sections is on the increase globally. One is that pregnant women are getting older and heavier, and it is these older and heavier women that are undergoing more C-sections.

The latest figures (2016) show that 25 per cent of births in Western Europe were by caesarean delivery; in North America, it was 32 per cent, and in South America 41 per cent.

A caesarean section is often necessary when a normal delivery would put the life of the baby or mother at risk and this may include obstructed labour, twin pregnancy and high blood pressure. Others are breech birth or problems with the placenta or umbilical cord.

Dr Sesan Oluwasola, a consultant Obstetrics and Gynaecologist, University College Hospital (UCH), Ibadan, Oyo State, said aversion for caesarean delivery is still a major issue.

He added “society has made people believe that CS is bad, and so most of our women still hold on to that belief. But it is very safe; it is better than it was 20 years ago due to advancement in medical practice.

“The time you do the operation, the anaesthetic competency that we have now and the type of operation that you do now, has made it quite safer than it used to be. For example, we do not put people to sleep 90 per cent of the time anymore.

“Because the woman is awake, her response after the surgery is better, she losses less blood and then she goes home on time. Again because of the type of cut you make on the skin and on the womb, you are not going to wait until the womb is healed before she goes home.

“In fact, the way you close the womb, the woman does not have to come back to remove the sutures after seven days. All those had made it better and also the improvement in antibiotics.

“The antibiotics we have now are very strong unlike the olden days penicillin and so on.  So, the infection that will make the woman stay long in the hospital is being taken care of. She is up and doing immediately. Also, we have strong painkillers such that if the woman does CS today, in some places, six hours later, she can begin to eat.”

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Dr Oluwasola, however, said that stigma for CS was partly due to cultural beliefs on the procedure, adding “even at many antenatal clinics, pregnant women are against having their babies through CS. But the midwives who lead the song also need to let them know that there are occasions that warrant it. These include when the baby is too big, twin pregnancy and high blood pressure.

“They should look at the bigger picture; if you force yourself to deliver the baby, the baby may die and you may end up with VVF. Now some people because of the complications of VVF, are not able to get pregnant again. So, it is a whole lot of issues, but CS is now better than it was 20 years ago.”

Contrary to many people’s beliefs, Dr Oluwasola assured that babies from CS do not have any abnormality what so ever.

He declared: “That struggle through the birth canal does not build immunity; the passage through the birth canal only squeezes the fluid that is in the baby’s lungs out and the baby coming out of the stress begins to yell. It does not do any other thing.”

Although there are major and minor reasons why a woman may be advised to have her baby through CS, he declared that women after the first CS stand a risk of having their next baby through CS.

“She already has a cut and when she is going to have the next baby, the chances of doing another baby by CS is 50:50. And if she has done CS two times, then the next delivery will also be by CS.”

For example, after a previous CS or as a result of a possibly recurrent issue, like being short or having a small pelvic size, it is not advisable to deliver vaginally.

Irrespective of the fact that CS is good, it doesn’t come without risks because anything surgery could have complications. Every surgery has its own complications.

Also, a review, published in PLOS Medicine, looked on the long-term health benefits and risks associated with having a caesarean delivery on the health of both the mother and the child compared with a vaginal one.

The study, conducted by the University of Edinburgh, is based on an analysis of the combined data (a “meta-analysis”) of one large randomised controlled trial and 79 observational studies, all from wealthy countries. In total, the number of participants included in the studies was almost 30 million.

Compared with vaginal delivery, there is a decreased risk of urinary incontinence and vaginal prolapsed with a caesarean delivery. And pregnancy after caesarean delivery was associated with increased risk of miscarriage and stillbirth, as well as several subsequent pregnancy risks such as placenta previa and uterine rupture, but not of neonatal death.

Women who had a C-section were 17 per cent more likely to have a miscarriage if they decided to become pregnant after the caesarean and 27 percent more likely to experience a stillbirth.

The risk of placenta previa, on the other hand — a condition in which the placenta grows in the wrong part of the womb — was 74 per cent higher for mothers who had a C-section, and the risk was even higher for placenta accreta or placental abruption.

There is an increased risk of asthma (21% increased risk) and the risk of obesity (59%) in children up to the age of five, compared with children born by vaginal delivery.

The findings are significant, given that more and more women are opting for a caesarean delivery instead of a vaginal one – a lot of the time without having been medically advised to do so.