To push or not to push: Mother-child considerations as C-section deliveries rise


Insurers say they have seen a jump in Cesarean section deliveries, commonly referred to as C-sections, accounting for close to 70 percent of their maternity bills. PHOTO | SHUTTERSTOCK

Childbirth is no fun, but some scars and pains can make it worse. At a time when insurers say they have seen a jump in Cesarean section deliveries, commonly referred to as C-sections, accounting for close to 70 percent of their maternity bills, we ask women if given an option they would give birth naturally or surgically.

“I would rather have five elective C-sections [where a woman chooses the date of delivery through surgery] than crawl on my knees due to labour pains,” says Mary Ng’ang’a.

“I had accompanied my aunt to the hospital to deliver her firstborn. From the experience, I vowed never to undergo the same pain. Her water broke, but she was not in labour. The doctor induced her, and after one hour she started going under the bed screaming due to severe pain. In the long run, she still ended up in the theatre for a C-section,” she says.

Ms Ng’ang’a says when she got pregnant, she already knew what she wanted.

“So I walked the whole journey with my gynaecologist and got the baby through surgery. Everything is okay save for back pains later on,” she says.

The 35-year-old bank teller is a mother of three, and all her children were born through C-section.

Mary Wanjiku, in her early 30s, has had two C-sections.

“My pregnancy journey was okay but when the due date came, I laboured so well, until the last minute when the doctor dropped the bombshell. Surgery,” Ms Wanjiku, who works as a digital marketer recalls.

The doctors said the baby was in distress, she says.

“With the second pregnancy, I decided to do an elective C-Section because my scar was under two years. I was advised it was too early to push because complications might arise,” she says.

She, however, says given an option, she would pick normal delivery because it does not limit the number of pregnancies a woman can safely deliver.

You can also give birth back-to-back, pregnancies that are less likely to be high-risk as opposed to C-section,” says Ms Wanjiku.

Despite having a third-degree tear when she was delivering her first child, Ann Kiminda says she will always opt for normal delivery.

The mother of two says that although she has not experienced a C-section, she would still prefer a vaginal stitch to a knife through the tummy.

“The healing process, I believe, is much easier and quicker as compared to C-section. Also, one gets to connect with the baby through the pain and it’s not a lifetime scar,” says the 27-year-old.

To push or too posh? This is the question Kenyans are grappling with as statistics reveal elective C-Section is on the rise.

Critics argue that C-sections may not be unnecessary because hospitals have protocols before granting the surgeries.

Doctors recommend surgery if a woman is deemed mentally unfit to give birth naturally or if the baby is in the breech position or distressed or when the lives of the mother and baby are in danger.

“I wouldn’t say that most pregnant women are opting for C-section. But yes, more than before women are opting for C-sections by choice for various reasons including; the convenience of scheduled birth, fear of the pain, process, length, and/or complications of labour and attempted vaginal birth before poor labour experiences.

“Others are concerned about fetal harm from labour and attempted vaginal birth, concerns about trauma to the pelvic floor from labour and vaginal birth, and subsequent development of symptoms associated with pelvic organ prolapse, as well as need for control,” says Dr Edgar Gulavi, a resident obstetrician and gynaecologist at Avenue Healthcare in Nairobi.

“Also, the newer techniques of C-section like being on half-body anaesthesia have made it a relatively safe and predictable procedure and also makes some pregnant women choose this as an option as well.”

“At Avenue Hospital, the percentage of women who opt for the elective C-section is about 22 percent of the total deliveries. We have about 100 deliveries at the hospital per month,” adds Dr Gulavi.

The cost of a C-section delivery in Kenya varies from hospital to hospital with some charging as high as Sh400,000.

Just like any other medical procedure, C-Section has risks.

“Short-term maternal risks include infection, bleeding, injury to pelvic/abdominal organs, blood clots, back pain, and longer recovery time compared to vaginal delivery. Short-term risks of planned cesarean birth on a baby include neonatal complications such as breathing difficulties. There are also some long-term risks such as chronic pelvic pain, scar formation in the abdomen (adhesions),” he says.

Is there a relationship between childhood allergic diseases and C-section mode of delivery?

“No research has dispelled this theory. Initially, it was thought that C- sections don’t allow babies to interact with their mother’s microbiome (bacteria located in the birth canal) and that lack of this interaction led to an increased risk of childhood allergic diseases like asthma.

In the large studies done over long periods, it was shown that mode of delivery did not influence the development of these diseases,” says Dr Gulavi.

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