Caesarean section
Pros and cons
Many mothers describe it as a hard-hitting, intense pain which comes in waves, placing immense pressure on the pelvis.
“It feels like griping pains, like when you have the runs. They come and go, building in intensity, and when you have this pain in your belly, or back, or both, your bump goes rock hard,” one mother commented on a forum on UK website Baby Centre when she was asked to describe contractions.
Could this be part of the reason why, after enduring contractions for hours or even days, some mothers-to-be turn to their doctors and beg for a Csection?
Sister Lora Schreiber, a nurse at East London birthing centre Metro Maternity Home, agrees.
Schrieber has on occasion assisted moms who’d insisted on natural birth throughout their pregnancy. Then, while in labour, they stopped the process midway because they could not handle the pain.
“They usually ask for a Csection and we immediately refer them to a hospital for a follow-up,” she said.
“There are also those who opt for a C-section instead of natural birth right from the start. This could be women giving birth for the first time who are afraid of what they don’t know, women who have had a natural birth before and are afraid of experiencing the same pain again, or those who have heard scary stories from other women.
“There are also those women who want a C-section because it gives them more control.
“With a C-section, you can decide on a date and a time with your doctor beforehand.”
The number of C-section births has increased worldwide. According to research released by the Lancet journal last month, C-section numbers climbed from 16 million (12.1% of all births) in 2000 to 29.7 million (21.1%) in 2015.
A recent report by South Africa’s Council for Medical Schemes said in the past year there were 590 C-sections for every 1,000 births. The ability to pay, rather than clinical reasons, was highlighted as the main reason.
Now the World Health Organisation (WHO) has sounded the alarm about women having C-sections unnecessarily.
For the first time, the WHO has issued guidelines in an effort to reduce the number of unnecessary C-sections.
The recommendations, released last month, incorporate the views, fears and beliefs of women and healthcare professionals.
Issues, such as the limitations of some health systems, were also taken into consideration.
Key recommendations in the guidelines include:
The provision of childbirth training workshops for mothers and couples;
Relaxation training programmes led by nurses;
Psychosocial couple-based prevention programmes;
Psychoeducation for women with fear of pain or anxiety;
Doctors to get a second opinion before undertaking a Csection; and
A staffing model with midwives at the forefront, backed up by 24-hour assistance from an obstetrician providing inhouse delivery without other competing clinical duties.
East London-based doctor, Robyn Spring, said an inability to handle pain was not the only reason a natural birth turned into a C-section.
According to Spring, planned vaginal deliveries most commonly failed due to cephalopelvic disproportion.
“Which means the head of the baby is too big to pass through the pelvis of the mom. Labour will start, and will then stall,” she explained.
She said the signs she looked out for included the failure of dilation of the cervix, the position of the baby’s head and swelling of the baby’s head.
“This gives us clues as to what is unfolding inside. The other most common reason for an intrapartum [in labour] caesarian is foetal distress, where there is not enough oxygen getting through to baby, during the labour process, leading to characteristic foetal heart rate changes.”
Besides the cost associated with C-sections, which is slightly higher than a vaginal birth at private healthcare facilities, the WHO warned of a number of short and long term risks to the procedure.
These risks can extend many years beyond the delivery.
They include harm to the bladder and blood vessels, infection, a longer time for the mother to heal after the birth and lost bonding time with the baby following birth.
“There is most definitely a shorter recovery time after a natural birth, unlike with a Csection which results in a wound which needs to be managed carefully to avoid infection.
“The mother is also in pain after a C-section, pain which needs to managed with painkillers, often for days following the birth,” Schrieber said. C-sections also require a bigger staff complement.
Bruce Janssens, regional manager of the Life Healthcare Group in the Eastern Cape, said with a caesarian section, more staff were involved because the expectant mother goes into theatre. Schrieber said women who give birth via C-section should not feel ashamed.
“There are those women who feel that they are superior because they managed to give birth naturally, sometimes looking down on the women who give birth via C-section which is sometimes viewed as ‘easy’. That could not be further from the truth,” she said.
“No matter the birth process, the only thing that matters at the end of labour is a healthy mother and baby. No one is going to point at you in the street and laugh if you gave birth via C-section. Similarly, women who have had a natural birth are not heroes. They don't deserve any more praise than any other woman. All of these women are mothers, no matter how the baby was born.”