#EMMAseries: An Indepth Series on Caesarean Sections by Dr Uche Iwuh (PART 1)

Q : Some women believe undergoing a Caesarean section is a sign of weakness; like it makes them less of a woman. Others view it as some taboo and pray it away. As a man and also an ob-gyn, how do you view it?

A: Firstly, a caesarean section is an operation (surgery) to deliver a baby through a cut on the mother’s abdomen and another cut on the uterus. It certainly is NOT a sign of weakness to have a caesarean section (c/s). There are indications for having a c/s and very often for the women and babies involved; the vaginal (commonly called natural) route may lead to disastrous consequences. From a man’s point of view, I believe that as long as there are assurances that mother and child will be alive and healthy at the end of the procedure, there is nothing wrong with a caesarean section. As an obstetrician, I see a caesarean section for what it is: An alternative route to achieve the birth of a baby, a lifesaver and a miracle in itself. However, it may be that for some, the fear of delivery via an operation, which in times past was understandable because of the number of deaths that would occur, or complications that left those that survived, scarred, still persists.

 

Q: Some women believe that doctors suggest a caesarean section because it is an easier and more costly process. What is your take on this?

A: There are clear indications (reasons) for performing caesarean sections, except of course where the pregnant woman herself decides not to attempt a vaginal delivery. In most cases, therefore, caesarean sections are performed because they are indicated and necessary. The use of electronic monitoring (for the baby) in labour is known to increase the rate of intervention. It is true that with advances in healthcare, caesarean sections have become safer today than in times past, and consequently are performed more frequently. It also takes a fraction of the time that labour would take and without doubt however, it is more costly; but suffice to say once again that there are clear indications for performing caesarean sections, and whenever the obstetrician feels the risk to the mother or the baby from a vaginal delivery exceeds that from operative intervention, a caesarean section should be performed. The emphasis here is on obstetricians (who have been trained to have the best interest of the mother and child in mind when taking these decisions).

 

Q: In what circumstances is it advisable to carry out a caesarean section?

A: The reasons for which a caesarean section may be done include: conditions which may complicate pregnancy or are pre existing, such as pre eclampsia, diabetes, placenta praevia, previous history of a classical caesarean section, higher order multiple pregnancy(triplets and above), HIV infection of the mother, sexually transmitted diseases such as active genital herpes, a past history of 2 or more previous caesarean sections, previous uterine rupture, past history of vesico-vaginal or recto-vaginal fistula repair or previous pelvic floor or anal sphincter repair. Conditions that complicate labour such as: prolonged labour that fails to progress, feto-pelvic disproportion, fetal distress, cord prolapse, placental abruption, abnormal lie, presentation/positions (breech, transverse lie) etc. It could also be done simply at the request of the mother, as a preference. There are many more reasons than can be included in the list above but once again it is important to mention that if the risks to either mother or child from a vaginal delivery exceed that from a c/s, the latter should be undertaken. Of course there will be practitioners who believe that a vaginal delivery is feasible but remember that as the family size keeps getting smaller, each child should be given the best possible start and chance in life.

 

Q: How long does the average c/s take? As a patient or family member waiting outside, how does one know there is a problem?

A: A caesarean section should take between 30-60 minutes depending on the skill and speed of the surgeon, and the degree of difficulty as a result of the indication (reason). You may suspect there is a problem if the surgery is taking too long, people suddenly start running around, you are approached to donate/procure more blood or simply if someone speaks to you and explains what is going on.

 

Q: What should a patient expect during an elective or emergency caesarean section? Is it a good idea to have an elective c/s?

A: For an elective c/s, the reason for having the c/s should have been explained in the clinic and the process, procedure and possible complications explained. The patient would usually be admitted to the hospital the night before the surgery and expected to fast from about 10p.m. The anaesthetist would discuss the options available and with the patient and choose an ideal option. A consent form would be given to the patient for her signature. She may be given medication to calm her down and help her sleep overnight. On the day of the surgery she may get some premedication, 1-2 hours before the surgery. When everyone is ready, she is taken into the theatre, an intravenous line(drip) sited, monitoring leads attached, anaesthesia induced, a urinary catheter inserted and following preparation of the operation site by cleaning, she is covered with sterile linen, leaving exposed the site to be operated on, and the procedure commences. After the surgery, she will be taken to a recovery room where her vital signs are monitored and she would be looked after until she is stable enough to be moved back to her ward/room. In an emergency situation, all the above preparatory steps/ processes are moved through more rapidly. As to whether it is a good idea to have a caesarean section, if there is an indication, then it is necessary and therefore good. If the question however, is whether a woman without clear cut indications for a c/s should opt for one, then I guess that the answer is that it is a personal choice that is well within a woman’s rights as long as she understands the decision she is taking and its implications.

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