No woman should die while giving birth understanding caesarean sections

One facebooker asked, “Why do you have over 2000 C/sections a year in one hospital alone?” .During my childhood, i never heard of a woman giving birth by C/section or undergo an operation but i vividly remember many women in the neighbourhood never coming back home after being admitted in “labour”.
The question by the facebooker reminds me of the many questions people have. I have learnt and grown up knowing many beliefs about pregnancy and childbirth. One such belief is “inchila”. A traditional belief that when a man cheats or has sexual relations with another woman while his wife was in labour or pregnant, his wife would have a difficult delivery or in modern times, would end up having a C/section. I was working in labour ward about 6 years ago when i told my patient that she wont have a normal delivery and that we need to do a C/section because the baby was in breach. I remember being prayed for, though, the grandmother was more interested in casting the demons out of me than praying for God’s wisdom to be with me when doing the operation.
Many people ask?

• Why are there so many C/sections today
• Are hospitals commercialising C/sections?
• What causes one to have a C/section?
• Does a man have to cheat for the wife to undergo a C/section?
• Quite difficult questions i believe especially that they border on our African beliefs.

What causes C/sections?

During my formative years of medical practice working in labour ward, i learnt of one common problem of labour…..obstructed labour. A general term which means that labour is not progressing as expected or baby is failing to move down the birth canal. Most C/sections are as a result of obstructed labour. The causes of obstructed labour are easily remembered as the 3 P’s: Powers, Passenger and the Passage. Powers refers to the problems with the uterus which can range from weak contractions to uncoordinated contracts. The Passenger refers to the baby! The commonest problem with the passenger (baby) is a condition called cephalo-pelvic Disproportionate (CPD) simply meaning the baby’s head is too big to pass through the birth canal or vice versa. Other problems with the passenger can be due to breech presentation or hydrocephalus (abnormal accumulation of water in the baby’s head) which can be a difficult delivery in most women. The Passage refers to the birth canal, where the baby passes during delivery. This is mostly affected by the bony pelvis abnormalities. They range from contracted pelvis, to android pelvis ( pelvis shaped like a man’s). Trauma to the pelvis can contribute significantly to distortion of the birth canal. Other recognisable causes of contracted pelvis in poor countries like Zambia are childhood malnutrition which results in stunting and short stature. Delayed labour can also be caused by obesity and diabetes in the mother resulting in fetal macrosomia a condition characterised by having a very big baby normal and/or having birth weight above 4kg. Such babies may get stuck during childbirth.

Why are C/sections common today?

One of the simplest reasons is that there are many more hospitals with qualified doctors capable of diagnosing obstructed labour and performing C/sections.Secondly, evidence has shown that there are better maternal and fetal outcome when a c/section is done early during obstructed labour. By performing a C/section early during obstructed labour, maternal complications like postpartum hemorrhage (PPH) excessive bleeding after delivery and , child birth injuries and use of delivery instruments to force the baby out are avoided. The last reason is mostly medico-legal. The fear by doctors to lose a baby which can result in a legal dispute.

Are hospitals commercialising C/sections?

One blogger once accused the medical fraternity of rushing to perform C/sections for commercial reasons. We should appreciate that the health care industries is one of the tightly regulated industries across the global. WHO recommends that the rate of C/sections should be between 10-15% of all deliveries. There is a clear correlation between c/section rates near 10% and reduced maternal and neonatal mortality. However, there is no benefit with c/section rates above 10%. Therefore, the 10% mark is a performance benchmark for all hospitals across the globe including our own hospitals here in Zambia. So hospitals with lower rates are bench-marked against their maternal mortality. If their rates of maternal deaths are high compared to the rates of C/sections, such hospitals are taken to task and interventions are put in place to improve the C/section rates. Hospitals with higher C/section rates too are interrogated and appropriate interventions put in place. So the public is assured that the rates may seem to be increasing, but there are tight controls that ensures that we remain within the normal ranges appropriate for each hospital.

In conclusion, C/section has nothing to do with the behaviour of the male spouse though the tradition itself is important as it maintains decency in homes. I should also mention that decision to do a C/section has nothing to do with the doctor suggesting it being “demon possessed”. Therefore, every effort should be made to pray for the doctors for meticulous hands rather than binding their hands to touch our loved ones. C/section have proved to be a life serving operation and many women can attest to that! The causes outlined above can be detected early if all women attended antenatal early especially before 12 weeks or in the first trimester.
Lets work together to improve maternal health.

No woman should die while giving birth.