Over the last several years, there has been a rising concern over the number of women who deliver by caesarean section (CS) unnecessarily. Local data is not easy to come by, but CS rates of above 30 per cent are not unheard of in city hospitals. US data shows about one in every three American children are born by Caesareans. WHO even attempted to define an optimal CS rate years ago of about 15 per cent, though this was later revised with a statement that the optimal rate is unknown. What is clear is that ever rising CS rates are not only undesirable, but they pose avoidable risks. There are situations where caesarean delivery is the only safe choice for the mother and her baby. Such conditions include complications like a low-lying placenta (called placenta praevia), a baby whose umbilical cord comes first, and other complications occurring during the pregnancy or labour. If there is an absolute reason to have a CS, there is not much to debate about. Questions arise when CSs get done for dubious reasons. Uncomplicated pregnancies, followed by an uncomplicated labour process hardly require intervention by Caesareans. But we have all heard about Caesareans on demand. This is where you request to have a CS without any medical reason whatsoever. Concerns also arise about CS recommendations from Obstetricians for reasons not backed by scientific evidence. Or a readiness to opt for CSs when other options may be applicable. For example those who have had a previous CS for a non-recurrent reason may be suitable for a subsequent vaginal birth. And recent evidence does not support capping the duration of labour to traditional limits, only serves to increase interventions that may be avoidable. Questions about financial motives for doctors and hospitals as a key driver for high CS rates remain. If you find yourself about to have a CS, you must clearly understand the balance between benefits and risks. The benefits of a vaginal delivery for both you and your baby still far outweigh any benefits from unnecessary CSs. Even though CSs are pretty safe, complications still occur that include infections, blood clots, bleeding, injuries to other organs, and delayed recovery among others. The first CS puts you at a high risk of subsequent pregnancy complications that include abnormal placentation, and consequent repeat Caesareans. Don't take CS deliveries for granted. If you are requesting for one, think again. Why do you want to avoid a vaginal birth? Your fears may be addressed in other ways, pre-labour birthing classes may ease your anxieties. Adequate pain relief during labour comes in handy and there are several options to choose from. If a CS becomes necessary, make sure you understand the reason for it before giving your consent. If any doubt arises especially in non-emergency situations, you could always seek a second opinion prior to agreeing to the CS.
photo: thriveandflourish.org