CAESAREAN SECTION: The Fallacies and Facts

DG was a 27-year old woman in her 39th week of pregnancy; her first pregnancy ever. Her 36-week pregnancy scan showed that her baby weighed 4.1kg. The following discussion ensued between her and the doctor.

Doctor: ‘‘Mrs DG, considering the big size of the baby in your first pregnancy, it is risky if the baby is delivered through your vagina.’’ The doctor explained to her that her pelvis may not be able to accommodate such big baby to pass through. He also stated that the womb may not have enough power to ‘push’ the baby through the vagina. ‘‘A Caesarean section is safer,’’ he counselled.

DG: ‘‘God forbid I do surgery. I would have my baby myself. Doctor, do all you can to make me have my baby without surgery.’’

Doctor: ‘‘(explaining further danger of her decision), okay, we will allow you initiate labour naturally and observe your progress. If progress is unfavourable for either you or your unborn baby, we would have to resort to Caesarean section.’’

DG never returned when her labour pains started. She rather went to a maternity home where her details were not known. She had painful, difficult, and prolonged labour which lasted over 20 hours. The baby died at delivery. DG also sustained numerous injuries to her genital area.

KM, a 36- year old woman, was in her 37th week of pregnancy, her first ever. The baby had been in a persistent transverse lie for a period of two weeks. She was attending her antenatal clinic when her doctor informed her of the need to have a planned Caesarean section done due to the abnormal position of the baby in her womb. ‘‘You will not be able to have your baby through your vagina,’’ the doctor told her.

‘Okay,’ KM said. ‘‘So long my baby and I are safe.’’

The surgery was done in her 38th week of pregnancy. Surgery lasted less than an hour. She and her baby have been fine.

The surgical practice of Caesarean section is as old as mankind. Therefore, several perceptions abound concerning this mode of delivery. From the clinical point of view, the doctor’s goal in the planning of the delivery of any baby is to have healthy mother and healthy baby. This can be achieved either by means of vaginal delivery or Caesarean section. Below are certain false perceptions and the corresponding facts.

                                                

Caesarean section is an abnormal mode of delivery. This perception is mostly shared among people who reside in developing countries. It is thought that surgical mode of delivery is improper. Some believe that the woman would not be fit enough to resume routine activities as a result of surgery when compared with vaginal delivery. Read more about CAESAREAN SECTION: The Fallacies and Facts

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Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the Medical Director/Chief Executive Officer of Nathaniel Health Consulting (a family hospital), Matogun, Ogun State. He is the editor-in-chief of The Family Doctors. He can be contacted via demolaorolu@gmail.com

SEIZURE: A Commonly Mismanaged Medical Condition

VC, a 26-year old fashion designer, is full of life. Everything is apparently fine with her but for the occasional convulsions she experiences. She gets confused after most episodes of seizures. This is in addition to the bruises she sustains. She convulsed while she was being proposed to. She had been avoiding medications to prevent seizures.

What is a seizure? Seizures are involuntary abnormal changes in behaviour of the affected individual due to erratic electrical discharges in the brain. It can occur in any age group, and affects both sexes. The stigma it causes makes persons who have recurrent seizures to be withdrawn. Some even deny its existence. The denial is more of a problem than the disease itself because the affected person will only seek attention if the condition had been acknowledged.
Any individual who experiences seizures needs to be evaluated closely to identify the cause. If the exact cause is found, appropriate treatment makes the person better. He or she may not have another seizure especially if only one episode had been observed. Individuals who have recurrent episodes of seizure are regarded to have seizure disorder.

What are the common causes of seizure? Some cases of seizures are temporary, meaning that once the cause is identified and managed appropriately, the individual may not have another episode of seizure. Some cases are recurrent.

  • Infections: Severe malarial infection as found in cerebral malaria may cause seizure. Bacterial, fungal, and also viral infections affecting the brain can cause seizure as a manifestation of the disease. In small children between 6 months and 5 years of age, elevated body temperature may also cause seizure. With appropriate treatment, the individual may not have another episode of seizure in his/her lifetime.
  • Brain injury. Some individuals experience seizures later in life as a result of injury sustained during birth leading to poor oxygen supply to the brain. Brain damage from severe jaundice in the first four weeks of life may also cause some irreversible changes in the brain that result in seizures later in life. Physical injury to the brain sustained during accidents may cause seizure in the future.
  • Brain tumours: Some cancers involving the brain may have seizure as one of the symptoms the individual experiences.
  • Metabolic diseases: Some rare medical conditions are characterized by poor metabolism of nutrients, especially carbohydrates and lipids. Seizure may be one of the symptoms of these rare diseases.
  • Withdrawal state of drug abuse: The brain of persons who abuse illicit drug is most times in a state of apparent quiet depending on the particular drug that is abused. Inability to use the drugs over a period of time results in what is called withdrawal symptoms. These symptoms may include seizures.
  • Stroke: Having suffered shortage of blood supply, parts of the brain may later in life give abnormal electrical discharges manifesting as seizures.

 

What are the perceptions and attitudes regarding seizures?

Read more about SEIZURE: A Commonly Mismanaged Medical Condition

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Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the Medical Director/Chief Executive Officer of Nathaniel Health Consulting (a family hospital), Matogun, Ogun State. He is the editor-in-chief of The Family Doctors. He can be contacted via demolaorolu@gmail.com

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