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The Caesarean Section:To have or not to have?

Agyeeeeiiiii, Agyeeeiiiii, eeeeeeei eeeeeeiii eeeeeeiii, mmmmmmmmmmmhhh, mmmmmmh!
Then silence, after about 10 mins the pain recurred.

These were the cries from Maame Shikpenkpe on the eve of the 6th March 2014. She had been in labour for over a day. When she was 36 weeks pregnant (almost 9 months), her midwife and doctor had suggested that she has a planned caesarean section (C/S) because her baby was very big and was coming with his buttocks (breech). The C/S would help prevent harm to her baby and herself during the delivery.

She was, however, scared by the thought of having an operation. Her response to her doctor was, I am a child of God, I will deliver like a Hebrew woman (the vaginal/natural way). As a result, she decided to stop attending the antenatal clinic and rather to show up in labour, deliver naturally and surprise everyone.
There she was in labour. Midwives did another vaginal exam to check the opening of her womb to see if the baby could come out. After so many hours the passage had not opened wide enough for her baby to pass through safely.
The midwife checked the baby's heartbeat, only to realize that it had become abnormal.
Her doctor was called in to repeat the examination and take a decision. Doctor concluded that she needed to have an emergency C/S to deliver her baby else baby could die or have brain damage.

He counselled her further but she still refused to have the C/S. She spoke with her mother, husband and prophet who after a word of prayer, advised her against surgery as that was not the will of God for her life and that God would intervene.
Another hour down the line, baby's heart beat had become very faint and mother was getting weaker. Husband finally convinced her to have the C/S.
Doctor quickly mobilized his team and performed the C/S for her. Baby was finally delivered, but came out looking bluish and could not cry. Resuscitation was started immediately and baby admitted to the neonatal intensive care unit (NICU). Baby remained on admission at the hospital's neonatal intensive care unit (NICU) for about 2 weeks before he started sucking breastmilk himself and crying.

Child turned 2 years on the 6th of March 2016, but he is unable to sit, walk or talk.
The same prophet now says it is her in-laws who are bewitching the child.

Let's now take a look at Caesarean Sections.
The myths:
'It is an artificial mode of delivery'.
'You are not a strong woman once you do not achieve vaginal delivery'.
'You will not be well enough to take care of your baby afterwards'.
'Surgery is the work of the devil'.
'Doctors give you medication during pregnancy so that the baby becomes very big so that you cannot deliver vaginally'.

What is Caesarean section?
It is a surgical operation for delivering a baby by cutting through the wall of the mother's abdomen. Every pregnancy will end in delivery either by vaginal or caesarean section. Having a C/S does not mean that the woman is weak or a failure. It takes a strong woman to carry a pregnancy to the stage of delivery. Any baby is blessed to be delivered by either means. Sometimes, the C/S is the only means to guarantee that the baby will be born healthy.
The C/S may be elective (planned) or done as an emergency.

Some reasons why a Caesarean Section may be recommended to you:
- When the pregnant woman is carrying two or more babies.
- When the mother is bleeding prior to delivery of the baby
- When artificial means of inducing labour has failed.
- When mother has severe medical complication during the pregnancy, such as hypertension, diabetes, heart disease, etc
- When mother has had major surgery on the womb such as for the removal of fibroid.
- When the mother has had two previous Caesarean sections.
- Fetal complications such as;
- when baby is very small baby or very big.
- when baby has difficulty breathing in the womb (foetal distress).
- when the baby is breech
There may however be other reasons for which your doctor may recommend a CS for your delivery.

Implications of refusing or delaying an emergency Caesarean Section:
Baby could be born blue (asphyxiated) and develop subsequent brain damage of varying severity which may be irreversible.
A very big baby could also be born with birth injuries like fractures and nerve injury.
Depending on the reason for the surgery, mother may even lose her life.

Possible disadvantages of Caesarean section:
More pain after delivery
Risk of wound infection
Longer stay in hospital after delivery
Future deliveries more likely to be by c/s
It is generally unsafe to have more than 3 deliveries by c/s

Care of the mother post surgery:
Mother may be in hospital for some days receiving treatment.
She will be given medications to reduce the pain from the surgery.
Once she gets better, she is discharged home.
At home, she continues the pain relief and antibiotics for a few more days.
She should not lift very heavy loads for a few weeks after the delivery.
She is, however, fit to do some chores at home and take care of her baby.
She should attend her first hospital review at 2 weeks or as recommended by her doctor.
She can have sexual relations with her partner as soon as she feels ready to.

Caesarean Section and breastfeeding:
Breastmilk may not flow immediately after the delivery. This may also happen even in mothers who have had vaginal delivery.
Sucking at the breast by the baby helps to establish breastfeeding.

In Conclusion, the Caesarean section is an acceptable way of delivering a baby which may be the only way to save the baby from brain damage, physical injury or even death. Women should therefore not refuse or delay the decision to have a CS delivery when it is recommended.

Dr. Hilda Mantebea Boye
Dr. Adzri Sackey
Dept. Of Child Health
Dr. Samuel Oppong
Obstetrics and Gynaecology Dept.
Korle Bu Teaching Hospital.