Today many negative cultural beliefs hamper the health of women and their babies and, by extension, societal health. While the effort of the science and health-care professions is important in improving women’s health, societal action is long overdue to assure pregnant women that Caesarian Section procedure is a safe option for a woman to deliver her baby. Chioma Obinna writes:
Child delivery for some women is as simple as ABC but for some women, it is a herculean task for some reasons beyond their control. While these lucky women deliver at home naturally, some also mover into the delivery room and deliver their babies safe and sound. For many other women, whether hospital delivery or home delivery is, challenges and complications abound, sometimes it becomes so fatal that it leads to loss of mother and baby.
The untimely death of 24- years-old pregnant Chizoba Okafor will remain indelible in the minds of her family. According to her neighbours, the pregnancy was her first attempt. She had just finished her national youth service and was lucky to have been married almost immediately after service.
But little did she know that her life would be cut short too soon. At seven months, her doctor had informed her that the child was not positioned very well after an ultrasound scan was carried out on her. That is what medical experts describe as malpresentation of the foetus. The doctor then told her that she should prepare her mind for a Caesarean Section, CS, should the position remained unchanged till the day of her delivery.
Sadly, on hearing this Chizoba became afraid. She began seeking all manners of advice from different women. At a point, she was directed to a herbal woman, who gave her some concoctions to take. As the months go by, Chizoba, stopped attending ante natal and focused more on the traditional birth attendants her neighbour introduced to her.
Chizoba is just one of many Nigerian women, who view the CS as not only abnormal but also a significant subtraction from womanhood. A few months later, she went into labour and was rushed to her traditional birth attendant’s home instead of the general hospital where she was told she had a challenge.
After labouring for two days without success, her husband decided to take her back to the hospital. Unluckily for her, it was too late as she had developed complications. Efforts to save her and her baby proved abortive. Chizoba and the baby died.
Chizoba is not the only Nigerian woman afraid of CS. Boade Ajibola was lucky because she is alive today to tell her story. This is not unconnected with the fact that in most part of Nigeria, women who deliver their babies through CS are seen as weak.
But the case of Boade, however, taught her and some women in her community a lesson. Boade was said to have been diagnosed with placenta praevia, a condition where the placenta presents before the baby. Out of ignorance and poverty, she never attended antenatal clinic. She is one of the women that believe that delivery is a natural thing and can be done anywhere because she had delivered three children. “I could not believe my eyes when the worst happened. The complications were so much that I was rushed to the general hospital, where I was transfused and operated immediately.”
“I survived because the doctors insisted they must perform CS immediately. CS saved my life, “she said amidst tears.
“Before now, most people in my village used to think that CS is the devil’s work. Most people attribute it to marital infidelity. Personally, I used to think that it is a ploy by doctors to collect more money,” she remorsefully said.
The story of Chizoba and Boade aptly describe the low awareness of the importance of C- Section and the trauma faced by many Nigerian women who are giving birth or about to give birth.
Every single day, Nigeria loses not less than 145 women of childbearing age due to the complication of childbirths according to 2013 National Demographic Health Survey, NDHS.
According to a joint report tagged: “Trends in Maternal Mortality: 1990 to 2015” by the World Health Organisation, WHO, UNICEF, World Bank and United Nations Population Fund, it is estimated that Nigeria has approximately 58,000 maternal deaths, accounting for 19 per cent globally, which also means that at least 800 women die in every 100,000 live births.
Also, the NDHS also estimates that annually, Nigeria loses 33,000 women, 284,000 newborn and 1,000,000 children under-five deaths.
Sadly, maternal mortality remains unacceptably high in Nigeria, ranking among the highest in the world and the rate of reducing these deaths have been slow as many of the contributory factors remain unaddressed.
Although there have been efforts geared towards addressing the problems, one of the major procedures that have been adjudged to be safe in reducing complications in child delivery, Caesarean Section, CS, a life-saving procedure has not been widely accepted by most women.
In a report study entitled: “Beliefs, perceptions, and views of pregnant women about cesarean section and reproductive decision-making in a specialist health facility in Enugu, Southeast Nigeria”, the researchers from the department of Obstetrics and Gynaecology, University of Teaching Hospital, Enugu, Nigeria noted that globally, the CS rate is estimated at 15 percent but in Africa, it is within the average rate of 3.5 per cent in Africa.
They noted that due to the progress in medicine, the procedure has become safer over the years, with many developed nations having rates well over the WHO recommendation of 15 per cent.
According to the study, Burkina Faso, Mali, and Nigeria all show CS rates below 2 per cent while more developed regions, including Europe, Northern America, Japan, Australia, and New Zealand, have an average of 21.1 per cent.
They further noted that despite the above figures, there has been a rising trend in CS within Nigeria, a developing nation in West Africa, with rates from 9.4 percent in the 1970s and 34.6 per cent currently, mainly from unbooked emergency cases. But they maintained that women in developing countries, however, remain averse to CS notwithstanding its ability to save a life.
Authenticating the report that unbooked cases of emergency CS was on the rise, a Consultant Obstetrician and Gynaecologist, at the Lagos State University Teaching Hospital, LASUTH, Dr. Modupe Adedeji explained that the rate of our emergency C-section is more than their elective (planned) C-section.
Why women need CS
Adedeji also explained that there are various indications that bring about delivery via C-section.
According to him, this could be due to some conditions in the mother, the baby or for both of them.
He maintained that the main reason for the intervention of C-section was to save the mother and the baby or both.
He explained that there a lot of indications that can predispose women including severe pre-eclampsia, abnormal lie and malpresentation of the fetus, multiple gestations with the leading twin malpresentation, fetal distress, cord prolapse or presentation, placenta praevia, abruption of placenta with a live fetus, fibroid occupying the lower part of the uterus, mothers with pelvic anomaly, mothers who have undergone vesicovaginal fistula repair, rectovaginal fistula repair and 4th degree perineal and obstructed labour among others.
Adedeji further noted that the common reason for a planned section was repeated section. That is a woman who had had previous 2, 3 or more sections.
“We at times allow one previous C-section to try vaginal birth if there are no contraindications to it. This is usually done in a hospital with clear supervision by trained midwives and doctors. So that when there is a need to revert to C-section it would be done immediately.
We find some women requesting for c-section due to pain from Labour and delivery. Because C-section is known to be safe now and safer anaesthetist measure are carried out.
Adedeji explained that currently, they are seeing women, who are averse to C-section due to ignorance, poverty and some bad stories they have heard.
He said the problem is more common with women in the low socio-economic class; those in the high aren’t left out due to ignorance mainly.
“Due to poverty and most times ignorance, our women-run to traditional birth attendants, so-called nurses, churches and some convalescent home with no coverage of doctors for a cheap delivery fee only to be referred to hospitals for emergency c section.”
Continuing, in an interview with Sunday Vanguard, the Consultant Obstetrician and Gynaecologist stated that C-section is very safe in Nigeria and can be used to reduce the rate of the country’s maternal and perinatal morbidity and mortality.
According to him, selected cases are done according to the skill of each cadre of doctors available in the teaching and government hospitals. “For private hospitals, this should be a guided choice due to so many hospitals springing up. A private hospital as a choice of delivery should have a working and equipped theatre with well trained skilled birth attendants and an obstetrician available all the times.”
In a media report, a gynaecologist, Dr. Akinola Oladeji, also noted that the increase in the rate of CS had been due in part to fall out of emergency cases.
According to Oladeji, many women patronize sub-standard health facilities or faith-based homes and by the time they are coming to the hospital, they already have at least one indication for emergency caesarean section.
“Another reason for the increase is due to economic factor in that some medical practitioner encourages it because of the profit to be made; it’s more expensive than normal delivery.
“In some hospitals, a C-Section goes for about N250, 000 to N300, 000 and for multiple births, it is more. We have up to four C-sections in a month in this facility,” he said.
Like the saying that what has advantages also have disadvantages, in a report, a Senior Lecturer in the Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital, Dr Ijarotimi Omotade, who noted that CS could be justified whenever the life of the mother or foetus could be in jeopardy if vaginal delivery was allowed but said although it is on the increase globally, it remains a cause for concern considering the risks associated with the procedure.
Omotade listed the risks to include maternal death, bleeding, dangerous clot formation in blood vessels, infection and anaesthetic complications.
The lecturer said as beneficial as CS is, there are risks involved with it just like other surgical operations. She advised that the procedure should only be done when medically indicated.
She stated that some Nigerian women now willingly opt for CS due to the pains associated with natural birth.
“Mothers are now also requesting Caesarean section because they want to preserve the tone of the perineum and vagina. Mothers, who want their babies delivered on a particular day like their birthdays, husband’s birthday, wedding anniversary, special occasions like New Year day, Christmas or other religious occasions are not left out of social factors.”
However, while there are divergent views on CS among Nigerians, health watchers say medical doctors should not see it as an avenue to make more money but see it as a tool in the reduction of maternal mortality and should be done by only qualified hands and when it is medically needed to prevent avoid increasing the country’s unacceptably high mortality rate.