Now you are pregnant. You are going to have a baby. You have checked yourself at the antenatal clinic as required by your doctor, bought all the necessities for the coming baby-clothes, pampers, dippers, nappies, name it. For you are the modern lady who has planned for this delivery with your partner.
But you just forgot one important thing: How are you going to give birth to your baby? Is it going to be vaginally through the birth canal or abdominally via caesarean section?
Although many women would cry foul when they are told that they are to ‘face the Knife’ or to undergo a caesarean birth, many women are increasingly preferring to go for caesarean section. It is no longer waiting for doctors to recommend the caesarean.
Christine, a 25 year-old mother of one from Entebbe says that some women prefer a caesarean birth because they perceive it to be pain-free. “They say that the operation is carried out under an aesthetic and therefore there are no pains of labour to be endured.”
“Some women get worried about how something as large as a baby could possibly fit through such a small opening (birth canal). Some of them even have fears that the baby may be ‘squashed’ and damaged in the process,” she says.
Christine also says that some women prefer a caesarean because it is clean. “The nature of the operating theatre is very different from the physical exertion of labour. No sweat and tears. The mess of amniotic fluid and blood is dealt with out of sight. There are no lumps of poo emerging from the rectum, pushed out by the baby’s head as it journeys down the vagina,” she explains. She however says that she cannot go for caesarean birth unless it is the only option left to save her life or that of the baby. “The most obvious disadvantage of caesarean is the post-operative recovery period,” she says.
Contrary to popular perception, delivery by caesarean section is far from an easy option. Caesarean mothers are never able to jump off the operating table and get straight back to normal. “The operation itself may be completely pain free but the post-operative recovery period rarely continues to be so. There is, of course, a range of painkillers to help mothers through the first few days,” says Christine.
“But even so, moving around, handling your new born baby and going to the toilet, all present their own difficulties and have to be tackled slowly and carefully,” she adds, while giving her sister Mary as an example of a mother who faced the difficulty.
Depending on the type, severity and response to treatment, the post-operative infections can sometimes be quite distressing and can slow the recovery rate quite considerably.
According to AIMS medical Journal of 2002 titled ‘vaginal birth after caesarean’, scar tissue or adhesions may cause long- term pain, bowel obstruction, infertility or miscarriage. “The scar may make repeat surgery more difficult,” the Journal explains in part.
The authors, Gina Lowdon and Debbie Chippington Derrick say that those against caesarean birth widely acknowledge that the baby plays a part in deciding when the time is right to be born. They say that babies born by caesarean section can show signs of being angry and do not appreciate being delivered before they are ready.
Since it has all these consequences, then, how come more and more women are said to be increasingly opting to give birth by caesarean? “The reasons women give have more to do with the unacceptability of what happens during what passes as ‘normal’ labour and birth, than the appeal of major surgery. The realities of what women experience in our labour wards today is hardly inspiring,” reads the journal. Just ask mothers who have given birth from general (none private) maternity wards of even our main hospitals like Mulago, Nsambya or Mengo to understand how unappealing the situation can be.
“It is no longer a private time where women give birth to their babies themselves, supported and cared for by a few known, trusted, and accepted attendants in a familiar atmosphere,” notes the authors of the Journal.
The authors also say that some women believe that vaginal birth today is dangerous for the baby. “Women sometimes have difficulty in believing that an experience that can be so awful for them can be any better for their baby,” they say in the journal.
They say that vaginal birth today is no longer the natural process that has served the human race so well for millennia.
Mama Fiona, who was attending to her expectant daughter at Mengo hospital, agrees. “During the normal birth, the head of the child may fail to go out and the doctors may have to use machines to pull out the baby. This is normal (vaginal) birth but it is also dangerous because machines can bruise the baby’s head and the vagina of the mother,” says Mama Fiona.
Next to her was Jane, another expectant mother. She says that some women fear that their vagina would enlarge and that this would contribute to strife between the husband and the wife when it comes to bedroom matters. “But that is nonsense. I can not risk my life because I wants to fulfill my husband’s sexual expectations,” she says to the amusement of the neighbors.
Jane says that some men push their wives to have caesarean birth for that reason (avoiding the enlargement of the vagina). “That is putting their wives at a risk. I hear there are special gynecologists who can carry out operations to narrow the path. Why can’t they try that option,” she says.
There are also social reasons for this trend. Chris Babiha, a male student of Kyambogo University, says that some women go for caesarean birth because they want to have fewer children than those their husbands want and also be able to keep their marriages.
“Sometimes, women find themselves in a dilemma. You find their husbands want say 10 children when the women want to give birth to only two. So, they opt for caesarean to get a reason of not giving birth to many children,” he says.
The AIMS journal however notes that although people give many credible reasons for opting for caesarian section as opposed to virginal birth, the major problem is the state of health care system and particularly the maternity services, which are less than desirable in many developing countries like Uganda.
Drs. Gina Lowdon and Debbie Chippington Derrick say that until such time when true midwifery can come to the fore and women are given the emotional support that they need during delivery, it is likely that numbers of women needing to opt out by requesting surgery will continue to rise.
This is because even some women who are well informed of the realities of caesarean birth maintain a preference for this form of delivery.
Why Vaginal birth?
(a) Babies born vaginally have a lower risk of respiratory problems. It is widely accepted that the contractions of labour help prepare the baby’s lungs to breathe air. Babies born by caesarean section have a higher risk of respiratory distress syndrome than babies born vaginally at the same gestational age. Adults with asthma are more likely to have been delivered by caesarean section compared with adults without asthma.
(b) It is also widely acknowledged that the baby plays a part in deciding when the time is right to be born. It has been commented that babies born by elective caesarean section can show signs of being angry and do not appreciate being delivered before they are ready.
(c) The passage down the birth canal also gives a baby a wonderful all-over massage that wakes up various systems in the body – cranial osteopaths claim to be able to detect whether a baby was born vaginally or by caesarean.
(d) Mothers who feel safe, confident and well supported rarely find the level of pain reaches the point where it becomes unbearable. Their hormonal state supports the process rather than fighting against it. Labour is not perceived as being a trial, the pain is more like that experienced by athletes when they are giving their all and trying their hardest. Labour and birth are often the hardest physical work a modern woman ever has to do, but can also be the most rewarding.
(e) A mother who has experienced a natural birth can generally walk unaided after the birth and can begin caring for her baby straightaway.
(f) A mother who has experienced a natural birth is usually able to become involved in family life within hours of the birth and can get back to normal daily life within just a few days.
(g) When the birth has gone well, the baby is often peaceful, quiet and relaxed. Also mothers feel stronger, both physically and emotionally. There is a wonderful sense of achievement and peace, of strength and control, of health and completeness, of being able to cope and get on with life in general. It is a very positive life-changing experience.
Why caesarean delivery?
(a) Caesarean can be scheduled. Because of modernity some people want to reach the extent of choosing the date of the baby’s birthday. To some people the child’s birthday is considerable important and they want to try as much as possible to ensure that their child is not born on the day they don’t like say March 13.
(b) A caesarean is quick in comparison to most labors. Some people believe that the quicker something can be achieved the more advantageous it is perceived to be- whether this is making a cup of instant coffee, washing the laundry or sending a communication. In our society time is money and quick delivery of a baby is a preferred option.
(c) A caesarean is perceived as pain-free. The operation is carried out under anesthetic and therefore there are no pains of labour to be endured. The “wake me up when it’s all over” scenario appeals to some women.
(d) A caesarean is clinical – and therein perhaps lies its biggest attraction. Planned caesarean birth avoids the necessity for the many probing of the vagina, which have become routine during what is termed ‘normal’ birth today. A woman can more easily maintain a degree of professionalism and detachment in her relationship with her careers since the private areas of her body are left unmolested and unsullied.
Source: Caesarean Birth/VBAC Information, Gina Lowdon and Debbie Chippington Derrick
