Separating fact from myth about Caesareans so that women are able to make the right choice based on what’s best for their babies.
A FEW years ago, it was reported that some celebrity mums in the United States, Europe, and the UK were opting for Caesarean sections because they were “too posh to push”. It had become all the vogue for pregnant women to opt for elective C-sections, scheduling the operations to suit their desires. Time magazine even reported that a young college student arranged her baby’s birth to avoid conflict with her final exams.
This controversial issue meets at the crossroads between medical ethics and a woman’s right to choose. Should a woman have a C-section just because she can? Should her obstetrician offer C- section as the first choice to avoid malpractice suits when vaginal births go wrong? Is a woman really making an informed, medical choice, or a personal one because she is afraid of the pain of a long labour?
On the flipside, C-sections are sometimes wrongly demonised even though they are medically indicated. Mothers who desperately want a natural, vaginal birth may find it hard to accept the fact that a C-section is safer for them and their baby.
Why Caesarean?
A Caesarean section, which is also known as a C-section, is a surgical procedure where the baby is delivered through an incision in the abdomen. A C-section is needed when the doctor decides that it is safer than a vaginal delivery, such as when pregnancy complications occur, or when a woman has had a C-section for her previous pregnancy. Some common complications that necessitate a C-section are:
- If your labour isn’t progressing – if you are in labour for too long due to your cervix not being dilated enough or if your baby’s head is too big to pass through your birth canal.
- If your baby isn’t getting enough oxygen – changes in your baby’s heartbeat may mean that your baby isn’t getting enough oxygen, and should be delivered promptly.
- If your baby is in an abnormal position – if your baby is in the breech position, meaning with feet- or buttocks-first, or lying horizontally across your uterus. Another abnormal position is if your baby enters the birth canal chin up or with the top of the forehead or face leading the way.
- If you are carrying twins, triplets or other multiples – when you’re carrying multiple babies, it’s more likely for one or more of the babies to be in an abnormal position.
- If there is a problem with your placenta – in some cases, the placenta may detach from the uterus before labour begins, or the placenta may cover the opening of the cervix.
- If there is a problem with the umbilical cord – if a loop of the umbilical cord slips through the cervix ahead of the baby or if the cord is compressed by the uterus during contractions.
- If your baby is very large – this is most likely if you have diabetes.
- If you or your baby has a health problem – if you have a condition such as diabetes, heart disease or lung disease or if your baby has certain developmental problems, such as spina bifida or hydrocephalus.
In these situations, refusing a C-section would be very dangerous to you and your baby.
Are elective C-sections wise?
As I mentioned in the beginning of the article, some women (or couples) choose to have elective C- sections instead of going through normal labour and vaginal delivery. It would not be fair to say that women only do this for trivial reasons, as they probably have genuine concerns about the outcome. Some women may have had an unpleasant experience with their previous vaginal delivery or had a severe vaginal tear that took a long time to heal.
Some women are fearful that too many vaginal deliveries can cause urinary or faecal incontinence in later life, so they prefer to avoid it. Others may want to time an exact birth date so that it will coincide with their family or friends who are coming from out of town to help them. It may not be a medical reason, but it has its practical considerations. While it is true that women should have the freedom to make this choice, they should also make an informed choice. They need to know about the potential risks of C-sections before they make this decision.
As a C-section is a form of major surgery, it takes longer to recover than a vaginal delivery. It also carries risks to the mother, such as increased bleeding or wound infection. The membrane lining the uterus may become inflamed and infected, a condition known as endometritis, causing fever, chills, back pain, foul-smelling vaginal discharge, and uterine pain. Other risks to the mother include urinary tract infections, blood clots, or adverse reactions to the anaesthesia.
Then there are also the potential risks to the unborn baby, such as possible breathing problems or injuries to the baby’s skin during the surgery. The risks I described are not meant to frighten women into avoiding C-sections forever. C-sections can be very important – as a second choice. If your doctor decides during labour that you urgently need a C-section to prevent further complications, you have to trust him or her that the benefits of a C-section outweigh the risks.
As for elective C-sections, make sure you consult your obstetrician to explore all the risks so that you know that you are making the right choice.
The Star Newspaper, Sunday December 13, 2009
By Dr NOR ASHIKIN MOKHTAR
