Why has delivering by C-section become popular?

The Ministry of Health on November 1, expressed concern over the high number of caesarean section births carried out in private hospitals. In the annual health sector performance report 2017/18 by the ministry, there was an increase in the number of c-section births carried out from 48,695 in 2016/17 to 60,071 in 2017/18.
The average ceasarean section rate in the general hospitals increased to 28 from 25 per cent with Nakasero hospital, Bethany Women’s Hospital and Mayanja memorial having the highest number of cases.

Dr Henry Mwebesa, the acting director of General Health Services at the ministry during the presentation of the report wondered, “The number of caesarian sections is very high and the question is; could it be for commercial purposes because you pay more than the normal deliveries?”
Private hospitals in the country on average charge at least Shs500, 000 for normal deliveries compared to C-section delivery that costs triple or four-fold higher.
Globally, the number of babies born through C-section almost doubled between 2000 and 2015 from 12 to 21 per cent of all births according to a report by The Lancet. While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is being overused.

The advantages
According to Dr Charles Kiggundu, a gynaecologist /obstetrician at Kewempe Mulago Hospital, women are meant to deliver normally through the vagina and this usually happens when the baby is at term.
The advantages that come with pushing a baby naturally are that when the baby is in the womb, its lungs are filled with fluid.
Hormonal changes that occur during labour start to clear the fluid and the rest is squeezed out as the baby passes through the birth canal.
Any remaining fluid is coughed out after the birth or absorbed by the baby’s body.

When fluid remains on the lungs or is cleared out too slowly as is the case for babies born via C-section, the baby may develop breathing problems and may require to be put on oxygen.
“As the baby passes through the birth canal, it ingests bacteria that contributes to its gut health and boosts its immune system. Babies born by C-section miss out on these crucial bacteria and are more susceptible to health problems such as food allergies and asthma,” he says.

Dr Evelyn Nabunya, a gynaecologist at Mulago National Referral Hospital also emphasises that breastfeeding is likely to start early in mothers that deliver their babies normally and will stay in hospital shorter than in a C-section.
“Despite the advantages, there can be some physiological vaginal birth after effects, like a bit of tearing of the perineum or a long labor, but the incredible joy that is felt when the baby exits in a natural way cannot be compared to anything ever felt before,” she says.

Experiences
Tracy Namyalo, 34, mother of three, has never given birth normally. She usually goes to hospital at 38 weeks of her pregnancy. Her weight and height are normal but she still opts for a C-section birth.
She says, “I was reviewed and the doctor said I was normal and can deliver a baby vaginally. I, however, cannot endure that pain. It is too much. I also fear the tear that usually happens to the perineum. So I opt for an operation although the wound takes a little longer to heal than it would be if it was a normal birth.”
Her contractions started at 6pm and were still on by 8pm the next day. Viola Kamukama was in intense pain and by this time, her cervix was only 4cm open.

“It was my first baby and I thought I would endure the pain so I tried pushing normally but I got tired. The baby was too big and the contractions did not stop. The doctor had said I would get anesthesia but I could not be still because of the contractions. By the time the operation was done, the baby was getting tired too.”
At her second delivery, Kamukama wanted to try pushing again but when she did, she got rupture of the previous scar so she had to deliver by caesarean for the second time.
“I seem to have failed to deliver normally. The next time, I will just go for a c-section because all my attempts so far have turned out futile.” the mother of two remarks.

When is it required?
According to the World Health Organisation, it is estimated that 10 to 15 per cent of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.
If you have a low-risk pregnancy, your baby is in the head-down position and you are at least 37 weeks pregnant, Dr Kiggundu recommends attempting a vaginal birth. This is also applicable for women who have had a previous caesarean and those who are expecting twins are encouraged to try to deliver vaginally if the conditions are right.
There are cases in which a caesarean is necessary for the safety of the mother or the child. When the mother has a small pelvic area, the passage for the baby becomes too small thereby requiring a surgery. This may also be dependent on the size of the baby and how it is positioned in the womb.

When the baby seems tired with a weak or abnormal fetal heart rate, an immediate surgery must be performed to save the baby. If a mother has had two C-section births, the integrity of the uterus is compromised so she cannot push
The situations such as prolonged labour, abnormal fetal heart rate, preeclampsia and problems with the placenta usually require a major surgery, so the mother delivers by C- section.

Professional advice
The increase in C-section births for non-medical purposes is very questionable because of the associated risks for both the mother and the baby.
According to Dr Kiggundu, the baby and mother in a C-section birth are eight times more likely to die than in the normal birth.
“My advice to healthcare professionals, hospitals, women and families is to only intervene with the surgery after they have weighed the risks and it is medically required to save the mother and or the baby,” the doctor cautions.

Where is the problem
More private hospitals are carrying out more C-section births than the general public hospitals and according to Dr Kiggundu, most of the referred cases of women that need a caesarean birth happen because women first want to get immersed in their career, make money and by the time they think of starting families and have children, they are too old. Some of them are already 40 years.

“An increase in age increases your risk of delivering by C-section. It is therefore advisable that women conceive before they are 40 years and maybe embark on their career afterwards,” he says.
Most women in the corporate world go for C-section births because they can afford it. He adds that, “Some of them never fall sick but are covered with medical insurance. I think they feel cheated contributing to money which they do not use, so they ask for a c-section birth.”