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. The fact is that both modes of delivery are normal. The reason for Caesarean section differs among individuals. Depending on the tolerance and natural strength of the woman, some women regain their fitness within a few hours after surgery. However, light duty is recommended following surgery to prevent break down of the surgical wound and possibly hernia in the future.
‘Spiritually’ weak women are the ones who permit Caesarean section to be done on them. Many times when women find themselves in situations where surgical option of delivery is recommended, some women begin to make several religious interpretations of the surgery. Many have lost their lives due to delay with decision making. The fact is God himself gave the doctors the knowledge of carrying out the surgical operation. So long caution and standard practice are maintained in such hospitals, all is well.
Delivery via Caesarean section is a sign of poor motherhood grooming. Some women have refused surgery on account that no woman in their family had been operated for delivery. Such ‘abomination’ therefore will not start with them. Such women even opine that people will perceive them to be unprepared for motherhood. The fact is it takes a woman who lives after delivery to become a mother. No woman should die during vaginal delivery when there is a safe alternative of surgical delivery.
Recommendation of Caesarean section is an opportunity for doctors to make more money. Sometimes, couples who have been told of the need to have their babies delivered via surgery perceive that the option of vaginal delivery was not tried so that the hospital could make money from the surgical fee. It is important to note that every doctor is guided by strict rules in the care of a pregnant woman. Rarely will a doctor recommend surgery if there is no logical reason for it.
Caesarean section increases the risk of death of the woman. While there is an iota of truth in this statement, most times, the benefit of the surgery to the woman and the unborn baby is far more than the risk of death. In this 21st Century in which we have available more qualified doctors and nurses compared to previous years, the risk of death has reduced. Also, blood transfusion facilities are now available to take care of persons who may need blood.
Recommendation: Every pregnant woman should attend regular antenatal clinics. During such clinics, several topics, including Caesarean section, are discussed. This helps to allay anxiety if surgical delivery becomes unavoidable.
Every woman should have her baby delivered in centres where they had attended antenatal clinics. This affords the health personnel to use information peculiar to the woman during decision making.
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 firstname.lastname@example.org