Religious, cultural and societal beliefs on Caesarean Section (CS) and other sundry factors are fueling high maternal and neonatal mortality in Nigeria. Daily Trust on Sunday examines some of the societal, religious and cultural colourations about CS.
Culturally, vaginal delivery, the natural childbirth process, is applauded by many society and women who endure such a process are considered strong and courageous.
Whereas those who willfully agree to CS as an alternative means of childbirth are perceived as weak and lazy.
The cultural pedestal for women who give birth naturally is an enviably high one that most women want to attain.
Because of some cultural and societal inclinations, some women who are required to undergo CS to enable safe delivery refused notwithstanding the inherent danger.
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For some, instructions from religious leaders against CS resulted in irreversible health complications and in some cases the death of both mother and child.
There are concerns also that stigmatisation of women who undergo CS also contributes to the growing number of women declining to undergo the operation, thereby leading to more maternal mortality.
Nigeria is one of the countries with a very high maternal mortality rate, with the country accounting for about 20 per cent of global maternal deaths.
According to the World Health Organization (WHO), the Maternal Mortality Rate (MMR) of Nigeria stands at 814 deaths per 100,000 live births.
Ranked high among religious nations of the world, Nigerians have been known worldwide to painstakingly follow religious tenets as handed down to them by their religious leaders.
While there are no exact statistics, there are, however, concerns that an alarming number of women die daily at childbirth due to their refusal to submit to CS because of their religious and cultural beliefs.
For others fortunate to survive, most are left with irreversible medical conditions as scars to show for it.
But does the method of delivery matter as long as the child is born and both mother and child are safe?
A recent case of a woman who refused CS because her pastor said she would deliver like “the Hebrew women” but lost her baby and her womb in the process has brought to the fore the impact of religious and cultural beliefs on how people view CS.
According to the report, the woman who happened to be a primer (first pregnancy) insisted on delivering the “normal” way because her pastor assured her of it.
Her case could be one out of many which might have gone unreported in the country.
Not woman enough
A number of women say there is a stigma over CS; that people view them as not being “woman enough” to give birth through the natural process.
Faith (not her real name), a mother of four who lives in Gombe State, had all four children delivered through CS.
She said, “I was told that as long as I start having my first child through CS, all the rest would be through CS.
“After my first CS, I prayed alongside my mother to deliver my next baby naturally like the Hebrew women. I drank anointing oil my mother brought from Jerusalem, but I still had to go through CS for all my children.
“My in-laws said I was not strong and that I refused to endure the process of natural birth. They even said that I just wanted to waste their brother’s money because CS at the time was N150,000.
“The doctors told me that having my babies through natural birth was risky because my babies were all big. I was worried about all they said and angry because they never considered my life or that of my baby, but thank God my husband did not listen to them.”
Blessing (not her real name) who lives in Abuja was also stigmatised by her husband’s cousin for going through CS.
Recounting her experience, Blessing quoted her in-laws as saying, “Because of fear, you couldn’t give birth to just one child, but allowed them to cut you open.”
She added that though she prayed for natural delivery, she had to undergo CS due to complications.
I opted for CS – Gift
While some women resort to CS as the last option, Gift, a mother of two, willingly opted for CS.
Speaking with Daily Trust on Sunday, Gift said, “I opted for it; they gave me options because the pregnancy was already 38 weeks and they advised that I should be induced to give birth, but I told them that instead of me being induced, I would prefer I did a CS.”
Speaking about being stigmatised after undergoing CS, she said, “Nobody has come to me to face me and to tell me you are not a real mum or you are lazy or whatever.”
Cosmas Olayinka, an Abuja resident who has three kids, all of who were delivered through CS, said that although doctors suggested his wife had CS for her first baby, she chose CS for her second and last babies.
About being stigmatised, Mrs Olayinka admitted that, “There are times that I have been talked to, but I have never felt less of myself as a CS mum.”
Unraveling CS myths
Daily Trust on Sunday discussed the myths surrounding CS with Dr Yamuna Aminu Kani, a consultant obstetrician and gynaecologist at the Rasheed Shakoni Teaching Hospital in Jigawa State.
She described CS as “an incision that is made on the abdominal wall and then unto the uterus with the aim of delivering a baby after the age of viability, which is the age that the baby can survive the outside world.”
She explained that there were many myths surrounding CS but that the most common one was fear.
She said, “Some believe that if you have one CS, you have to continue to have CS all your life.
“Many women have their babies vaginally after the first CS, depending on the indication, unless the indication is contracted pelvis; that is, those that have pelvic deformity that is recurrent in all deliveries. Otherwise many women have a CS because of many reasons like placenta previa and foetal distress.
Dr Yamuna added that the myths surrounding CS varied from locality to locality and that their contexts were dependent on the educational exposure of communities.
She said, “When you are in an elite environment, the myths that people believe tend to be different from what we have among the local people who have less education.
“Some who read a lot will tell you that they have heard that CS is easier than vaginal birth, meanwhile others will tell you that they are afraid they are going to die during CS. These are two opposite myths occurring at the same time.”
She further said that from experience, stigmatisation from CS are majorly cultural as society looked down on women as weaklings or not being “woman enough”.
She said, “The only thing I can say about the religious aspect is there are women who of course they have already been counselled that they are not going to be able to deliver vaginally maybe because of a contracted pelvis but they resort to prayer houses and taking religious concoctions thinking it they remedy the indications for a CS. Some of them end up with complications.”
Advising those that stigmatise women who undergo CS, Dr Yauna said, “There is no need to stigmatise any woman that is having a baby through CS. She has gone through the pregnancy just like anyone else and at the end of the day CS recovery takes longer than vaginal birth. So, it is not as if she is having it easy as they believe.”
For Dr Dawood Muhammed, Imam of the Kumbiya Kumbiya Mosque in Gombe State, CS is allowed in Islam, adding that husbands and wives had no reason to refuse CS.
On the issue of stigmatisation of women who undergo CS, Dr Dawood said, “It has nothing to do with Islam, rather tradition. Whosoever says that CS is prohibited has no reason in Islamic injunction except if he is ignorant about it.
“Originally, natural delivery was preferred, but if there’s a problem then they can opt for CS.”
Advising women that have bad impressions about CS, Dr Dawood said, “I will advise our people to go and have proper knowledge of Islam; let them try and get teachers to teach them about what Islam entails instead of doing things without reference from the Quran and the Sunnah of the Prophet (SAW).”
Also speaking, Reverend Ubasi Guruza of the Evangelical Church Winning All (ECWA) in Jos, Plateau State, said there was nothing wrong in CS.
He noted that many things needed to be taken into consideration when discussing people’s health, especially the issue of childbirth.
He said, “As a Christian leader, when I see some pastors who discourage their subjects or their members from going through CS I feel they have limited knowledge of the scripture.
“What is most important is that we understand that it is God that gives wisdom for medical science. So, if there is a need for medical intervention during delivery, the parents should not disregard it.
“Sometimes, especially for first-timers, you need adequate presence of doctors and guardians so that you are able to deliver your babies safely. If the intervention is CS, I encourage every Christian to submit themselves because in the long run if that is what is needed, what is most important is for the mother and the child to be separated in peace, in good health and the two of them return home alive and well.”