Posted by: Brigitte Rozario Post(s) by this blogger
In the past natural childbirth was the norm. Caesarean section was only done when the mother or baby was not doing well and only as a last resort.
Today, women are choosing to go for caesarean section for various different reasons - fear of the pain, fear of risks to their child, beauty, convenience, timing baby's birth for good luck.
Should a woman opt
for elective caesarean?
Jennifer Hor, parenting educator,
nurse and midwife with Jenlia Maternal Services:
We have to acknowledge that caesarean section rates have gone up a lot. I don't think that's just in Malaysia. It is something that has been happening in a lot of developing and developed countries. The way I look at it is how couples have been given information.
In developing as well as developed countries where people are getting more affluent, I think a lot of people have actually started to look at childbirth not as a natural or normal process of being a parent. The moment they get pregnant they think of looking for a doctor and looking for a hospital - it's very "medicalised". It is almost like pregnancy is a medical condition.
If you don't look at childbirth as a natural process then you would think of how to get out of it very quickly, so people want it to be very fast and obviously quite easy. That's why I say the information given to parents should be accurate so that parents can actually make better choices. A lot of people actually think, if I can get my baby out fast (via a caesarean) why do I have to go through labour?
Caesarean section should only be used as the last choice and it should only be done when recommended by the doctor or under certain medical conditions.
You will find there are people choosing to do a caesarean section. If you talk to a lot of mothers they will tell you they are just worried and frightened about the pain and they haven't got any proper preparation on how to manage the pain. So, a lot of them think that if they have a caesarean section it is a lot less painful.
A lot of times when I conduct parenting classes, women ask me about the side effects of the drugs (painkillers) but they don't ask about the side effects of a caesarean section.
If they have been given proper information they will know that it is a major operation and that you don't choose to have a caesarean section.
To sum up, couples should be given the proper information, and they should be properly prepared to manage the pain, because fear of labour pains is a genuine fear. It's not a perceived fear. And the pain is there but women have to realise that it is a normal and natural process and that means that they can do it. It would help if they can think positively that this is how they will manage the pain and that their body is built for it.
Vicky, a mother who chose to go for
One of the main reasons I opted for a C-section was because of fears of complications. I know a few people who actually had complications during delivery and they ended up with emergency C-sections anyway.
I have a friend who had complications when she was giving birth and her child turned out to be a blue baby who is now permanently brain damaged.
I also know of a few people who went for normal birth but ended up doing a C-section. For one person, the doctor found that the umbilical cord was around the baby's neck.
All these stories just frightened me.
Actually my husband and I went for all the ante-natal classes and learnt the breathing exercises for normal birth. I was so torn about whether to go for a normal birth or a C-section because with a C-section the husband is not allowed into the room. That was the saddest thing for me. That was why I was so torn. I knew my husband wanted to participate in the birth. In the end the baby's safety was our priority when it came to choosing.
I wasn't worried about myself; I was more worried about the baby.
One of the questions I asked the doctor
was whether I would be able to go for normal childbirth for my second
child if I had a C-section for the first. He said yes and that kind
of convinced me to go ahead. Hopefully I will be more courageous with
my second child and have more faith.
Dr Wong Pak Seng
Dr Wong Pak Seng, consultant
obstetrician, gynaecologist and fertility specialist:
C-Section is a very safe procedure, normally performed if it is evident that a vaginal birth cannot be optimally performed. The reasons for this can be related to the following factors:
* Baby is in an unfavourable position such as breech or transverse;
* Large baby, usually in excess of 4kg;
* A compromised baby, such as a growth retarded baby or a baby who has passed motion (meconium), fetal distress during labour; or
* Multiple pregnancy (twins or triplets).
* Medical illness such as severe hypertension, heart disease etc;
* Certain obstetric conditions such as placenta praevia;
* Slow progress of labour; or
* Maternal request or "horoscope baby" when the couple want the baby's birth to be on a certain date and at a certain time.
Nowadays, there are more and more women, because of education or lifestyle and the desire for a small family, who want to have a caesarean section. This is partly because they feel that if they go through normal birth, the female anatomy is distorted or they may suffer the risk of a prolapsed uterine.
Nowadays caesarean section is very safe compared to previously when there was a high risk of death, infection and bleeding. Nowadays, a caesarean section is quite straightforward.
But it is still an operation and there are still risks involved.
What are the short and long-term risks?
* Wound infection;
* Bleeding leading to blood transfusion; and
* Scarring; and
* Scar rupture especially during normal delivery for subsequent pregnancy.
Most doctors would allow caesarean on demand. However, the couple should be well counselled with regards to the risk-benefit ratio. They must also be aware that her next delivery should she get pregnant again could very likely be a caesarean.
The doctor's role is to provide the patient with the information and based on that they make an informed decision. So if they want to have an elective caesarean section then I tell them it's fine but it's a surgery after all so there's always the risk of bleeding and wound infection; if you try normal birth then it's part and parcel of a natural process, you see the baby immediately, you recover well, you breastfeed and the next day you go home. So if, despite that, they still want to go for the C-section then we will do it.
Out of a hundred women, 80 would have a normal delivery and 20 would have a caesarean. This is the usual number everywhere in the world. But in private hospitals, it's about 30-40 going for caesarean. Out of this number maybe about 10 would request for elective caesarean. The rest end up having to undergo caesarean for one reason or another.
If you have a normal birth, four or five hours later you can get up and walk to the toilet and the next day you go home. For a caesarean section, the same day you won't be able to move much because of all the tubes attached to you but the next day the doctor will remove all the tubes and you are encouraged to walk. The following day you can go home. That means you stay two nights. The third day is the earliest you can go home.
It will take two weeks for the external wound to heal and you can do some light chores. But a full recovery takes two months.
If the first caesarean was done for reasons that we don't think can recur then the chances of her achieving the second delivery naturally is good. But certain criteria are necessary such as she must go into labour spontaneously, the baby must not be too big, and the progress must be good.
If for the first delivery she tried to deliver normally but the progress was slow or the doctor checked and found that her pelvic bones are very narrow - these reasons will likely be there for the second delivery. In such cases the doctor will recommend she go ahead and do a caesarean instead of trying naturally for subsequent deliveries.
The more caesareans you do the more internal scarring occurs, particularly from the womb to the bladder. You can do up to three caesarean sections but beyond that it gets worse.
But because today more and more women are opting for caesarean it's not unusual to see women who are in their fifth caesarean. If the hospital takes all the necessary precautions, and there is a surgeon on standby in case there are any complications with the internal organs, if you prepare the patient, have blood on standby, then it is still okay to do it.
The greatest risk in going for so many caesareans is that the scar is going to be very thin now and there may be a risk of rupture.