Women ignore risks, choose C-sections over natural births

For the families left behind when a mother dies from an elective Caesarean-section, the rise of the C-section as a medical fashion holds a terrible aftermath.

Yet despite the greater risks, longer time in recovery and permanent physical damage, C-sections have become a seeming ‘must-have’ for Kenya’s urban elite.

For example, Jennifer decided to undergo elective surgery instead of vaginal birth four months into her pregnancy without any clear medical reason.

“I think I am too posh to push. I cannot imagine myself going through labour for more than 15 hours. I have heard lots of scary stories as far as labour is concerned. Why go through all that while there is another option?” she says.

Victoria, a lawyer in Nairobi who also opted for a C-section, is another in a generation of women that is choosing surgery because they claim natural birth comes with complications like tearing, long hours in labour, incontinence, the psychological and physical pain of pushing, and resultant changes in the original size of the vagina.

Some reported cases of poor treatment by health workers in some hospitals does not help the situation either. As a result, working class women are using their medical insurance to cover the high cost of C-sections.

But there is a growing concern that unnecessary C-sections are causing deaths and long term damage by putting women through a procedure meant for emergency use only.

When correctly administered, C-sections can prevent fatal obstetric outcomes. Moreover, C-section delivery rates are generally low in sub-Saharan Africa, according to a World Health Organisation study. Ten study countries in sub-Saharan Africa had national rates of less than 2 per cent and only five countries – Ghana, Kenya, Lesotho, Rwanda and Uganda – had national rates of more than five per cent.

These figures, however, only reveal the average percentage rate of total live births for the whole population.

C-section delivery is more common within the urban population, and much more common among the rich.

The WHO data collected from 2003 to 2011 reveals that, in Kenya, C-section delivery among the rural poor was 3.21 per cent of total live deliveries compared to 9.41 per cent among the rural rich.

In urban areas, C-section delivery was 2.69 per cent among the urban poor and 11.16 per cent among the urban rich. Such high rates have never been necessary, historically, to achieve lower maternal mortalities.

In the Netherlands, for example, maternal mortality had fallen below 20 deaths per 100,000 live births by 1950, when C-sections were associated with less than 2 per cent of live births.

“Generally the high increase in Caesarean section deliveries is being advanced by the development of fetus monitoring and pregnancy throughout the country. However, we cannot rule out the few conspicuous private institutions that are pushing pregnant mothers towards Caesarean delivery for personal benefits,” said Dr.

John Ong’ech, Assistant Director and Head of Department Obstetrics and Gynaecology at Kenyatta National Hospital. As Dr.Ong’ech explains, the bottom line is that if there are no complications with your pregnancy, a vaginal birth is safer than a Caesarean birth.

A vaginal birth is also better for future fertility. “A lot of women come to the clinic with their minds set on Caesarean delivery as opposed to vaginal birth.

As a policy, we sit them down and advise them not to go through with it by giving them both merits and demerits and circumstances surrounding Caesarean and vaginal births. Most of the times we manage to convince them in favour of vaginal delivery,” adds Dr. Ong’ech.

The risks of Caesarean deliveries include complications such as endometritis - an infection of the uterus - bladder damage, blood clots surrounding the uterus, haemorrhaging and the most common of them, sepsis, which invades the bloodstream when the Caesarean wound remains open. Sepsis is frequently fatal.

About half of all women who have Caesarean also suffer adhesions, which are bands of scar tissue that can make organs in the tummy stick to each other, or to the inside of the tummy wall. Adhesions can be painful because they limit the movement of internal organs.

It additionally takes many weeks for the wall of stomach muscles to reknit after a C-section, with women advised not to drive or lift heavy objects, and initially having difficulty walking.

To engender such risks and consequences perhaps speaks to misinformation. It is even questionable whether sexual function and vaginal contraction are diminished after vaginal delivery.

There are few studies into this and those that have done report a weak correlation. “Sex is all in the mind. Pleasure after delivery should remain the same,” says Dr. Ong’ech.