Monday, July 17, 2017

Caesarean Section: Why CS is becoming popular among Nigerian women - Experts

Why CS is becoming popular among Nigerian women - Experts

Dr Ijarotimi Omotade, a Lecturer in Gynaecology said the CS rate was on the increase worldwide and remains a concern considering the risks.

The Caesarean Section (CS)  option  in birth delivery is becoming popular among some Nigerian women,  a News Agency of Nigeria (NAN) survey has revealed.

Respondents told NAN in a survey across some South West states and Kwara that the increasing popularity of the procedure was hinged on  factors ranging  from medical reasons to social considerations  as well as  unethical  motive  to make profit.

Dr Ijarotimi Omotade, a Senior Lecturer in the Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, said  CS  could  be justified whenever it was  deemed that the life of the mother or foetus could be in jeopardy if vaginal delivery was  allowed.

Omotade, however,  said the CS  rate was  on the increase worldwide and remains a  cause for concern considering the risks associated with the procedure.

According to her, the risks include  but not limited to maternal death, bleeding, dangerous clot formation in blood vessels, infection and anaesthetic complications.

She said as  beneficial as CS is, there are risks involved with it just  like other surgical operations.

The expert maintained that the procedure should only be done when medically indicated.

According to Omotade, some  indications for CS  include when the passage (pelvis) is too narrow for the passenger (fetus), when the placenta or tumour is blocking the passage  and  when the womb (uterus) is in danger of a rupture.

Omotade, however, said apart from the  cited indications, many mothers in the country  now willingly  demand  for CS,  hoping to escape the excruciating pains of labour.

”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,’’ she said.

Similarly, Prof  Ernest Orji, the Head of Department of Obstetrics and  Gynaecology at OAU, Ile-Ife, said  majority of  pregnant women now request  for  CS because they do not want to pass through labour pains.

Some, he said,  also prefer to have their babies on special days to  mark their wedding or birthday anniversaries.

He said the trend had changed from the past when women were afraid of CS, adding that the procedure was now attractive with the availability of professionals and modern equipment for successful surgery.

But Dr Modupe Lawal, a gynaecologist  at Ladoke Akintola University Teaching Hospital, Ogbomoso,  said  CS delivery was  on the rise in Nigeria because doctors make more money from  the procedure than normal delivery.

According to Lawal,  what  most private hospitals  charge for CS  is higher than normal delivery.

Another practitioner, Dr Adewunmi Alayaki, however, said  it would be  unfair to believe that doctors who opt for CS were after monetary benefits.

Alayaki, the Head of Surgery Department, State Hospital, Ilaro, Ogun,  told  NAN  that a doctor’s first and paramount responsibility was  to save lives.

According to him, several factors could be responsible for the choice of  CS  by  any pregnant woman.

Some of the factors, according to him, are maternal factors, fetal factor and materno-fetal factors.

Others factors, he said, are age, body formation (short-statured woman), contracted pelvic and previous surgeries.

“When we look at it  in the long run, it is what we have in the society and some of the conditions that will make a doctor opt for CS.

“When we talk of economic gains to doctors, are we talking of doctors who work in public or private sector because for a doctor who works for government, the money is not going into his  pocket,” he said.

On how popular the procedure is, Alayaki said:  ”Times are changing and a lot of women are more enlightened now,  some of them even request for it.’’

When NAN spoke with some expectant mothers, some of them expressed  reservations  about  the procedure while some were positively disposed to it.

Mr Dele Hundeyin,  a father of two,  said  his  wife gave birth to his two daughters through CS.

“We have good doctors in government hospitals who take on this procedure and are good at what they do while their fees aren’t too exorbitant.

” It also saves a lot of time and the  agony my wife would have to pass through. So, I think it’s far better than the Hebrew delivery,” Hundeyin added.

A gynaecologist, Dr Akinola Oladeji, expressed the belief that the increase in rate of  CS had been due  in part to fall out of  emergency cases.

“A lot of people go to sub standard health facilities or mission houses 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 encourage   it because of the profit to be made; it’s more expensive than normal delivery.

“In our hospital, the cost of 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.

He also confirmed  that  the elite sometimes request for CS to avoid labour pains.

A  middle-aged petty trader, Mrs Florence Adeyemi, who is a mother of three teenagers,  said  she would not refuse a CS  if she were to be pregnant with a fourth child.

“The major reasons for refusal of a caesarean section is fear of death during surgery, but that fear has since been laid to rest when I saw my friends who have undergone a C- section and came out well.

“There is enough awareness now of the benefits of a C-section in preserving the lives of mother and child,” she said.

A 26-year-old pregnant woman said that she was planning  on getting a C-section so as to decide the birthday of her child.

“It is our first child and my husband and I have decided we want the birthday to coincide with our wedding anniversary,” the respondent, who refused to disclose her name said.

Dr Ismaila Busari, the Ondo State Chairman of the National Association of Government General Medical and Dental Practitioners, told NAN in Akure that CS offers mothers laxity to reject labour pains.

“She can fix any date which will be convenient instead of going through labour pains with its contractions.

“ Normal delivery might also come with vaginal tears which can never happen with CS.

“The baby doesn’t pass through the vagina with this process;  it is  cut out through the stomach.

“ CS usually also saves the lives of both mother and child when the labour lasts for a very long time without any progress,  even when the labour is induced,” he said.

He, however, said that CS has  many disadvantages,  including issues such as cutting of the uterus which could result in cutting the blood vessels accidentally.

According to him, the bleeding that occurs in CS is also usually much more than that of normal delivery.

He said that the patient might need blood transfusion due to blood loss, adding that this also has its own disadvantage.

Busari said that blood transfusion might lead to infections and diseases such as HIV and hepatitis.

“Even when the blood is screened,  the disease or infection might be in the window period and might not show up during screening,’’ he said.

“Also,  after CS, the mother passes through pain and stress due to the cut made to the stomach.

“ It varies, but the pain might last for months and  in some cases  will affect the mother’s daily activities.

“Infection of the cut from the operation can also occur if the cut is not treated or cleaned adequately.

“If the person is diabetic, then it won’t heal as fast as someone without diabetes,” he added.

Inspite of the increasing popularity of the procedure, it is still unappealing to some women.

A petty trader,  who simply gave her name as  Mrs Adebayo,  said that having a CS  was against her religious beliefs.

According to her, it is a sin for a Christian to choose the procedure.

A lecturer also expressed  satisfaction with  vaginal delivery, saying “I like to experience what it means to bring forth a child by yourself.

“ The pain you experience is one of   the joys of motherhood.

“Cesarean Section is a not  for me and  the pain of vaginal birth besides  is just for that moment compared to the lingering pain you experience after the CS,’’ the academic, who also craved anonymity, said.

The Chief  Medical Director of  Ekiti State University Teaching Hospital, Ado-Ekiti, Dr Kolawole Ogundipe,  said it had  always been  difficult convincing some pregnant mothers to go for  CS in the state.

He  said this was  inspite of the explanations on the risks of rejecting the procedure.

But the state Commissioner for Health, Dr  Olurotimi Ojo,  said hospitals in the  state were currently being equipped  with the right type of facilities  and personnel, saying pregnant women and their families had nothing to fear in whatever  circumstances.

An Ilorin-based matron, Mrs Saratu Bello, also said many had died for rejecting the procedure in Kwara.

“Giving birth through CS is not a death sentence  and the earlier expectant mothers realised  this  the better for them.

“’They should know that before medical personnel decide to carry out CS on any pregnant woman, it is to save the life of either the mother or child or both of them.

“But when you want to remain adamant that you must give birth only through vaginal delivery, caution needs to be taken,” Bello said.

The matron said she was compelled  to speak out on the development when expectant mothers began to pray against undergoing the procedure during ante-natal sessions.

“I became surprised that it is now like a norm because they (pregnant women) now pray against it during ante-natal sessions.

“What they say is that they want to deliver like the Hebrew women, so, I know it’s a religious belief which has cost a lot of women their lives and needs to be tackled.

“That compelled  me to see it as a point of duty to educate them more  on the need for them to allow things  take its due course,” the matron said.

Bello said it was surprising that some Nigerians had continued to live in the past regarding  CS  while  some expectant mothers eagerly  opt for it in other countries


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