Why our women are lining up for C-section

A few months ago the National Health Insurance Fund (NHIF) called for research to determine why over 42 per cent of women seeking maternity services opt for surgeries as opposed to normal delivery.

According to data from NHIF, the number of women seeking birth surgeries called Caesarian Section had increased and was nearly at par with women going through normal deliveries.

In 2014/2015, the NHIF paid out health insurance maternity claims for a total of 61,420 births nationally of which 20,773 of new mothers underwent C-section.

NHIF Chief Executive officer Simeon ole Kirgotty said the numbers are alarming and it was unclear why at least 34 per cent of women were undergoing the procedure. Last year, NHIF paid Sh390,895,384 insurance claims for 21,721 women who underwent the C-section.

It is an alarming trend in the eyes of Kirgotty. But should it be alarming to women?

In a bid to find out why there was a sharp and steady decline in the number of women pushing their way into motherhood, Eve Woman spoke to some experts and mothers.

Facing the scalpel

Our conversation with Dr Stephen Mutiso of Kenyatta National Hospital in Nairobi began with him saying, “Natural birth is the best”.

“Natural birth means less complications and hence quick healing process on the mother’s part. C-Sections take up to six weeks to completely heal,” Dr Mutiso says.

It is what made Judith Wairimu declare that she will always brave the pain of labour in subsequent pregnancies. “Labour was painful as expected. But I did push – successfully.

When the baby came out all the pain dissipated into thin air like I had not been in labour for the last eight hours,” Judith says.

Today, she is a mother of three. All her children were born naturally.

However, for Maureen Musyimi, things didn’t go according to her birth plan. She is a mother of one. She had hoped for a vaginal delivery but after nearly 19 hours of labour she took her doctor’s advice to face the scalpel.

“I was injected on my back and the CS was done in less than an hour,” Maureen says. “It was so easy and painless. Looking back I can understand why a woman would want an elective CS. It is not necessary to go through so much pain when there is a painless option.”

Maureen’s CS was performed at one of the leading private hospitals in Nairobi. She had an insurance cover and hence it was easy to pay for the procedure which cost six figures.

Easy way out

On average, CSs are double, triple or even quadruple the cost of normal delivery. The procedure takes 40 minutes on average, making it the easier option for many doctors.

“Recently, CS has been passed off as a less painful option. There is also the tendency on the part of some practitioners to make it an easily available option for new mothers. Knowing that a CS costs a lot more than normal delivery, and it lasts less than an hour, it is an irresistible deal for a medic,” comments Lucy Muchiri, a midwife at Eve’s Mama, a midwife clinic and birth centre.

Muchiri advocates for natural delivery for the obvious reasons: one heals quickly and is ready to go back to normal life almost instantly. Recognising that majority of women want CS to avoid the pain and anxiety synonymous with labour, she says that pain is inescapable whether through normal delivery or CS.

“Every woman was created with the ability to give birth. CS is not painless; the pain comes after the procedure. Forty five days, later a woman is still agonising over a wound that needs to heal,” she says.

Lucy is not against the procedure, which she says, has proven critical in emergency situations. She is against C-Sections where a woman could have given birth normally. The surgery, she says, is employed in critical situations: like when the foetus is in breach position; the baby is in distress; active labour has gone on for more than 10 hours.

Ethical issues

According to Bernadette Muendo, the nurse in charge at Syumile Health dispensary in Makindu, a patient can be referred for a C-Section when abnormal developments are registered. But she rarely receives cases that have needed a CS.

The dispensary is not able to provide such extensive services and can only refer critical patients to the nearest Makindu District Hospital.

“On average 10 children are born here every month through normal birth. That is quite a number compared to about six CS referrals we have issued in the past year,” she says. It is not rocket science, she says. Once her patient dilates to 10cm she will proceed to see the labour through.

Here in Nairobi, a CS may not necessarily result from the complications that would warrant for the surgery. This, argues Lucy, has created an avenue through which the procedure can be exploited for monetary gain, a scenario which, according to the medical board, is unethical.

In the opinion of Dr John Ong’ech, a gynaecologist, a CS is warranted in a situation where either the mother or the baby is in danger.

Sometimes, he says, the baby may be too big to make it past a mother’s pelvis and therefore a CS would save both of their lives.

Ong’ech fundamentally agrees that normal delivery is widely considered better than CS. But even so, he doubts if normal delivery portends any obvious benefits for the baby.

“There have been hypotheses that normal delivery improves the baby’s immunity. To the best of my knowledge these are just theories. There’s yet to be concrete proof,” he observes.

No heavy work

Edith Mwando, a mother of one, went through C-Section that was informed by unexpected bleeding. Looking back she credits the procedure for keeping her and her baby safe. She however decries the notion that the procedure is good because it alleviates pain.

“Going through an elective CS is among worst decisions a mother can make. It takes long to heal and one is not allowed to do heavy work up to six months later. I wish I could have gone through normal delivery,” she says.

When she goes into labour – any time from now – actress Liz Njagah says that she will be pushing.

“I know a CS is the easier way out but I am willing to endure the pain. I think God created a woman’s body with the ability to handle labour. I will push all the way,” Liz, who recently held a baby shower, says.

She hopes no complications will arise to force a surgery.