C-Section isn't as bad as we make it

2014-09-23
THE PUNCH Newspaper- Solaade Ayo-Aderele

Recently in the news, a multigravida mom (a woman who has had more than one child delivery) died while she was attempting to have her third birth, which happened to be a set of twins.

Before now, the 30-year-old has had two Caesarean Sections and her physician had advised that because of her medical history, she should still undergo a C-Section for her recent delivery.

For whatever reasons, the doctors who attended to her when she went into premature labour at six months of pregnancy didn’t take her medical history into consideration, but allowed her to attempt to have the babies vaginally. She and the babies died two minutes apart after the bungled delivery.

Not my portion!

You’re probably aware that in religious circles, it is absolutely normal for expectant moms to be told that “they (referring to doctors) will not use knife to bring out your baby on the day of delivery.” The gory reference to “knife” is enough to send cold shivers down the spine of anybody.

Who needs C-Section?

Consultant Obstetrician, Dr. Grace Emmanuel, allays fear that anyone may entertain about C-Section, saying though it’s not just for the asking, several factors may predispose a pregnant woman for it. What are these factors? Read on.

Emmanuel says your doctor may suggest a C-S if a scan reveals that your baby has developmental abnormality, such as hydrocephalus (a condition whereby the foetus has fluid in the brain).

“The essence is to prevent further injury to the already delicate head of the baby because the stress that sometimes attends vaginal birth might do more damage to the baby. But when such a baby is delivered via the C-Section, doctors are able to control the situation, do proper assessment of the baby and advise as necessary,” Emmanuel explains.

Physicians also say premature labour is one reason why physicians may have to do C-Section for a pregnant woman. According to Public Health Specialist, Dr. Waleola Olagoke, though only one in five cases of premature labour results in C-S, doctors sometimes resort to it if the health of the mom or baby is threatened.

Again, obstetricians warn that in case of multiple births, a pregnant woman may not be allowed to undergo vaginal delivery. In the case of twins, physicians say, the mother may be allowed to have them vaginally if all the indices are right; but certainly not when you’re talking of triplets or more!

Again, physicians say, a woman living with HIV is not advised to have vaginal birth. “The reason is quite straightforward: it is to prevent possible mother-to-child-transmission of the virus, which can happen if she attempts vaginal birth,” Olagoke says.

He adds that since the attending physician already knows the HIV status of the pregnant mother, care will be taken to ensure that no blood crosses from the mother to the baby during delivery — a situation that may not be guaranteed were she to have vaginal birth.

Furthermore, when a baby is not lying head down and face back, he may have to be delivered through the C-Section.

“Such babies are referred to as being in a breech such as presenting buttocks-first; or transverse, such as lying across the womb. If a baby has not turned around head down by around 38 weeks, the doctor will advise surgery to be done anywhere between 39-40 weeks,” Emmanuel says. The ultimate is to ensure the safety of mother and child, she adds.

Again, problems with the womb (uterus) or the cervix may predispose a woman to Caesarean Section; while problems with the placenta, such as a placenta that is abnormally developed, is lying too close to the cervix or a placenta that separates from the inner wall of the uterus before the baby is delivered may all make the mother to be advised to undergo a C-S.

“In the case of the placenta, a placenta may obstruct the birth canal, medically known as placenta previa, which may cause severe and life-threatening bleeding; or it may separate from the inner wall of the uterus (womb) before delivery. This condition is medically called placenta abruptio.

“In many cases, either of these conditions may make the woman undergo C-S in order to preserve lives,” Emmanuel says further.

Doctors also warn that if a labour stops suddenly or if the vital signs of the woman in labour show that labour is not progressing the way it should, then the physician might suggest a C-S.

Paediatrician, Dr. Rotimi Adesanya, says should the foetal heartbeat slow down, speed up, or become irregular during labour, the mother may be taken through a C-S.

“This is called foetal distress and it is a sign that the baby isn’t coping well with the stress of contractions as labour progresses. As such, the attending physician may suggest a C-S to save the baby,” Adesanya explains.

Of course, a baby’s birth size can also determine whether or not the mother would undergo a C-Section, physicians say.

“I once had a patient whose baby weighed 5.8kg at birth. When we took the delivery via a C-Section, the newborn was bigger than the average four-month old baby! There was no way the mother could have had him vaginally without getting enormous injury if ever she survived it,” Emmanuel reveals.

Again, certain medical conditions concerning the pregnant mother can make doctors to advise surgical delivery. Such health issues include hypertension, preeclampsia or eclampsia.

“For any of these conditions, physicians would rather play safe by suggesting a C-S so that they can control everything and ensure the safety of both parties,” Olagoke submits.

‘Normal’ birth after C-S

As for women who may desire to have a vaginal birth after a C-Section, physicians say you must seek the professional counseling of your doctor, who is in a better position to advise.

“The main risk of having a vaginal birth after a C-S is because your uterine may rupture, in which the C-S incision re-opens during delivery,” Emmanuel warns.

 

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