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CS vs Vaginal Delivery: Understanding the options

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CS vs Vaginal Delivery: Understanding the options

A recent report by the World Health Organization (WHO) has highlighted a significant increase in cesarean section (CS) rates worldwide, raising concerns about maternal health and the associated risks of the procedure.

In Nigeria, many antenatal women still view cesarean delivery as an abnormal method of childbirth. Various studies have explored women’s perceptions of antenatal care, indicating a slight increase in acceptance of CS, though it remains limited.

The WHO describes cesarean section, or C-section, as a surgical procedure that delivers a baby through incisions in the mother’s abdomen and uterus. This major surgery is performed when a vaginal delivery poses risks to the mother or baby. Dr. Kunle Olayinwola, a consultant gynecologist and obstetrician at Lagos State Teaching Hospital (LASUTH), explains that CS involves “a surgical incision on the anterior abdominal wall and the uterus to deliver the fetus and placenta after the age of viability.” He notes that in Nigeria, the age of viability is considered to be twenty-eight weeks, compared to the WHO’s definition of twenty-four weeks, reflecting the country’s health environment.

A Cesarean section (C-section) is not the traditional method of childbirth and is typically performed due to complications. According to Dr. Olayinwola, the indications for a C-section can be classified into absolute and relative categories.

Absolute indications, which can be maternal or fetal, include:

Maternal indications:

1. Previous C-section: A prior Cesarean delivery that has not fully healed.

2. Pelvic abnormalities: A contracted pelvis or an obstruction in the pelvic canal.

3. Cardiac conditions: Medical conditions that impede normal Valsalva maneuver during vaginal delivery.

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Fetal indications:

1. Placental failure.

2. Umbilical cord prolapse: The umbilical cord is situated below the baby’s head.

3. Malpresentation: The baby is in a breech position or footling breech.

4. Macrosomia: The baby is larger than normal.

5. Congenital anomalies: The baby has a birth defect.

Regarding the perception of Cesarean sections among pregnant women in Nigeria, Dr. Olayinwola noted that most women still prefer vaginal delivery, even if they are not suitable candidates for it. However, he observed that there has been an improvement over the years, as more pregnant women and the general public are becoming increasingly aware of the procedure.

A study on child experiences and maternal attitudes towards cesarean sections (CS) indicated that over 80% of mothers prefer vaginal delivery, regardless of their eligibility for it. To address this situation, health care providers often engage in extensive counseling to persuade mothers to consider cesarean delivery when necessary. Notably, the small percentage of women who prefer CS are primarily multigravida, meaning those who have been pregnant and delivered before. Their reasons for this preference often stem from the pain experienced during previous deliveries.

Similarly, a report by the World Health Organization (WHO) states that the proportion of births by cesarean section has increased dramatically. This rise is attributed to various factors, the most common being the fear of pain during natural birth, including the discomfort caused by uterine contractions. Additionally, the ability to schedule deliveries at convenient times for families or healthcare professionals and the perception that cesarean sections may be less traumatic for the baby contribute to this trend.

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While cesarean sections can be lifesaving in certain circumstances, they are not without risks. Women who undergo CS are more likely to experience complications during delivery and may face longer recovery times. There is also an increased risk of infection compared to vaginal delivery, especially in Nigeria, where not all primary healthcare centers are adequately equipped with the necessary tools and facilities. A viral video by Dr. Egemba Chinonso Fidelis, known as Aproko Doctor, highlighted the poor conditions of a primary health care center, showing a lack of proper electricity, insufficient medical equipment, and unsanitary conditions.

However, experiences can vary significantly depending on the healthcare facility. According to Dr. Olayinwola, cesarean sections are like any other surgical procedure, and proper measures are taken to ensure patient safety. This includes maintaining a clean environment for the operation, sterilizing instruments, and ensuring that all medical staff—doctors, nurses, and other attendants—are properly equipped with scrubs, masks, and sterile gloves.

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