Legend has it that when Aurelia Cotta was about to give birth to her son, Gaius Julius, a serious complication arose that had the attending doctor reach for a knife and slash her abdomen to deliver the baby. Then, the fable goes, Julius Caesar was born and his name would be immortalised by the surgical procedure for ever more.
A Caesarean section, or C-section as it is often called, is a surgical procedure in which an incision is made through the mother’s abdomen and uterus to assist in the safe delivery of a baby.
It is either performed as an elective procedure – planned and scheduled – or as the result of an emergency because of maternal or foetal complications, including prolonged labour, foetal distress, a prolapsed umbilical cord or other cord abnormalities, uterine rupture or placental problems. Increased blood pressure or increased heart rate in the mother are also high-risk factors and so are the baby being in a breach or transverse position, when an induced labour has failed or when there is an oversized baby, which can occur when the mother has diabetes.
Other reasons why a C-section is considered are when there is a multiple birth, or when the mother is HIV positive or has a sexually transmitted disease such as genital herpes that can be passed on to the baby through a vaginal birth.
Although regarded by many healthcare professionals as a more controlled way of giving birth, the huge increase in C-sections has led to claims that some doctors perform this procedure as a matter of routine.
In the private healthcare sector in South Africa the rate is extremely high, with estimates of C-section births comprising about 70% of total births, compared with only 18% in the public sector.
The World Health Organisation has previously stated that no region in the world is justified in having a C-section rate that exceeds 15% of all births. However, in 2010 it withdrew this recommendation, stating that “there is no empirical evidence for an optimum percentage. What matters most is that all women who need Caesarean sections receive them.”
That said, it is obvious that not all women who undergo C-section births need to have the procedure for any medical reason. Doctors fearing litigation has been cited as a reason for getting a C-section. So, too, have the financial and lifestyle benefits to the obstetricians.
Ability to give birth
As the debate continues, a comment was made by a leading official of the Royal College of Midwives in the United Kingdom that resonated with many: “Not only has society’s tolerance of pain and illness been significantly reduced, but women are also scared of pain and think if they have a Caesarean there will be less, if any, pain.” The official concluded: “Women have lost their confidence in their ability to give birth.”
To assume that there is no pain or discomfort associated with a C-section, which requires an incision of between 100cm and 150cm long that would then be stapled or stitched, is being sanguine in the extreme.
It certainly takes far longer to recover from a C-section than from a natural birth. Moreover, mothers need to abstain from strenuous physical work or athletic pursuits for up to six months after the procedure. And having another child should not be planned for at least 18 months after a C-section.
Although rare, C-sections also share the same risks that go hand in hand with any surgical procedure: infections, surgical injury and blood clots, as well as the anaesthesia-related risks to the baby. Studies have also shown that women who have multiple C-sections are more likely to have problems with later pregnancies.
But, ultimately, the the decision to perform this procedure can only lie with the attending medical practitioner. Expectant mothers just need to be fully informed of all the pros and cons of all the options, including natural birth, so that they can make an informed decision.
C-sections will be the topic of Bonitas House Call on May 12 at 9am on SABC2