“I don’t even want to contemplate labour,” said Sadia Bello in response to her preference for natural birth to a c-section. “I saw my mother go through it for our last born and I don’t want to experience it. That’s why I opted for CS. It’s tidier and quite affordable especially if you have insurance.”
A general worry expressed by a good number of women like, Eunice Oziegbe, who spoke to Daily Trust Saturday on the matter was the fear of their ‘bodies’ not tightening back. “Growing up, I would overhear my grandmother and her daughters talk about their sitting in hot water with alum after delivery to get their bodies back in shape so that their husbands wouldn’t complain after they had recovered.”
Oziegbe was in secondary school when she understood what these words meant. “When I got married, I decided I wouldn’t want to go through that and would have CS. Thankfully my husband agrees with me, especially since we only want two children and I can go abroad to have them,” the expectant mother quipped.
There are several cases of women opting for c-sections rather than normal births. Against the notion that affluence pushes most to it, Daily Trust Saturday in the course of this report discovered other reasons for the trend.
Jayne Audu (not real name) has three children all of whom she had by CS. She suffered prolonged labour in the first pregnancy and was advised to undergo CS to deliver the child in order not to stress her. Her second pregnancy three years after was normal until a scan towards her delivery date revealed that the umbilical cord was twinned around the baby’s neck. “I was told that I couldn’t push because it could strangle the child. The only alternative was to have surgery. I didn’t want it but had no choice on the matter,” she stated.
Realising she was pregnant a third time two years after, Audu was excited as she yearned for the experience of having natural birth and ‘feeling like a woman.’ Her joy was short lived on her first antenatal visit. “I was told right away that I would not be allowed to go into labour because I had had two previous surgeries. My heart sank. I could feel it drop when the words landed on my ears. I was so inconsolable and cried my way home. It took my husband consoling me and the doctor actually spelling it out to me in black and white what the dangers were if I took the risk of having a natural birth,” she said.
“Weighing the options, I knew better than to insist. Although I feel cheated in a way, I am grateful to be alive to take care of my daughters,” Audu added.
Azira Bulus weighs 60 kilogrammes and is 5.1 feet tall. She was told her pelvis was too narrow to push her 2.98 kg baby and she should consider CS.
“I was terrified of the pain initially but I quickly overcame that with the joy of knowing I won’t be torn and have to toil with the fact that my ‘body’ may not return to being the same afterwards,” said the mother of one. “The wound from the surgery took longer to heal, than a normal birth would have I was told, but I didn’t mind because in the end I really don’t have any scars to remind me of the experience.”
Ina Sadiq and her husband were very excited when they first learned she was expecting their first child and the excitement grew as the pregnancy progressed very steadily. “I didn’t have the basic symptoms that come with pregnancy. No nausea, no sleepy sensations or even those feverish conditions I had heard about. If anything, I was more energetic. The gynaecologist we saw after every antenatal session also told me my record was very good and I should have no problem ‘when the time comes’ which made me all the more excited,” she said.
Displeased with the other delivery facilities in the hospital, the Sadiqs sought to use another hospital in Maitama. “The first time we saw the gynaecologist there, he suggested I have a scan done and some blood and urine tests which came back good. However, he informed me that from the result of the scan, my baby was big and could potentially cause problems during delivery,” Ina narrated.
This was news as this had never come up: “Regardless, we listened to him as he explained how my height was not proportionate with the weight of the baby. At this point to be honest I was rather confused but in all, concerned about my baby’s health. He eventually suggested CS as the better option given ‘the circumstances.’”
The CS took about 30 minutes but the baby wasn’t as big as the doctor claimed and I was unhappy to learn that other mothers with babies bigger than mine had had normal deliveries.
Dr. Henry Osazuwa, says a lot of private hospitals don’t allow women to labour: “In the course of my practice I have seen that when you allow them to labour, up to 60 percent of them have natural births.”
On how true it is that there is a rise in more affluent women opting for c-section the obstetrics/gynaecology consultant said it is true to some extent: “There is a trend towards the rise. Family sizes are smaller now; people like to have fewer babies. Natural birth is seen as painful. I think if pregnant women are encouraged, more of them would opt for natural birth.”
He added that: “Some only opt for CS when there is an indication for it. It is no longer a good reason for women to have CS just because they want to.”
Osazuwa, who is an ardent advocate for natural birth, said there are circumstances where CS is unavoidable: “Women who have had two previous c-sections, CS is safer for a third birth. Also when the baby is big, or is lying across, transverse, in some cases where there is a breach, CS is safe.”
He added that: “In some women the placenta is before the baby. For these, if they try natural birth, they are likely to bleed. Then also emergency cases like when the blood pressure is very high and the attempt to control it is not working.”
On complaints that most hospitals don’t give proper options on birth methods and financially exploit the patients, Osazuwa said: “I have seen women express these concerns. That is why they have to be careful when selecting their hospitals. Ideally, doctors should still opt for natural birth. It is the safest mode of delivery.
He noted that CS cases were driven by several factors, including the hospital wanting to make more money, and then the patients being unaware or ignorant: “Those who pursue such patterns are more than those who want to do the right thing.”
President of the Nigerian Medical Association (NMA), Dr. Kayode Obembe, stated that hospitals that promote CS against proper counselling of patients in order to make money run contrary to the ethics of the profession.
“Before intervening in any situation you have to explain to your patient to, who then signs a consent form. And a doctor found wanting will face the consequences of his action.”
He explained that: “With the increase in expertise and with available technology for the practice of obstetrics, there will be rise in the number of CS happening. You can’t allow a woman to be in labour for 48 hours. So you opt for CS rather than allow her and the baby to suffer.”
On worries expressed by women, Obembe said: “CS or normal delivery does not prevent the ‘body’ from returning to normal. Everything will undergo evolution, back to normal. There are methods of making a woman go into labour without pains. The system is perfect enough, so when people want, they opt for that. The drugs that are used in trying to reduce or remove labour pains, the mechanisms used also have their own complications which the patient may not know about. You find that women who opt for CS are those who are affluent and can afford to do it locally or abroad.”
He explained that nothing has changed as far as pregnancy was concern, just that there are better methods of diagnosing the problems before they cause disaster. There is Tita monitoring systems. When a woman is in labour, the heartbeat of the baby can be monitored. If the baby will die in the womb it is shown on the screen.
“This is a warning sign and you can easily go and do a CS to bring out the baby. There are also methods to monitor the uterus when it is contracting. With these gadgets, if there will be a problem the woman can quickly be rescued via CS. This is what we call prophylactic obstetrics. No woman is expected to die in the course of childbirth. These methods have reduced child and maternal mortality,” Obembe said.