Caesarean Section- The Myth, The Realities

Childbirth by any means other than through the birth canal is considered a feminine failure in the typical African setting. Every Africa woman wants to prove herself womanly competent by giving birth to a child through the vagina, a task no man in this world can perform. Indeed birth through the vagina is the natural way of bringing a child into this world.

Caesarean section, the art and medical science of delivering a baby through an incision in the abdomen dated back to antiquities. Legend has it that Julius Caesar; greatest Roman emperor of all time was delivered by this means. However the first authenticated case was in the seventeenth century (precisely 1610A.D). The medical world has since then attempted to perfect the breakthrough. But the problems of pain, blood loss and infection threatened the popularity of this life-saving procedure until the advent of anesthesia, safe blood transfusion and antibiotics.

Today caesarian section is commonplace in the developed world, because of its ability to make the obstetrician achieve his primary goals of the care of the pregnant. These goals are

1. Safe motherhood, by which is meant a live, healthy mother after delivery.

2. Safe babyhood, i.e. giving birth to a live, quality baby that is the pride of the family.

Any results short of these is regarded as an obstetric failure. A mother would want to be congratulated after nine months of the uncertainties that is associated with pregnancy. And having given birth, would want to flaunt the product of her conception before the world. If it takes caesarean section to achieve this, the medical world believes it is all well and good.

The birth canal is about five centimeters long. But, short as it is, passage through it is the most tedious and most dangerous journey a child will ever take in his life. To be sure, the fetus is at the mercy of other people during labor, he himself being completely powerless and unable to do anything about his own situation. Fortunately, mother-nature has put in place intrinsic mechanisms that make parturition an achievable process in up to eighty percent of pregnant women. The remaining twenty percent will need one form of assistance or the other if the obstetricians’ noble goal must be achieved. Of these seventy five percent would be by caesarean section.

The developed mind of the western citizen has weaned itself off the sentiment and taboo associated with caesarian section as a feminine failure and so the procedure enjoys maximum acceptance in that community. This may be so for some reasons. Firstly that society is more concern about the quality rather than the number of babies. Secondly the health system has put in place mechanisms that make finance of the procedure a secondary consideration. Thirdly, the fear of high morbidity and mortality associated with caesarian section in pre-anesthetic and pre- antibiotic era has been substantially allayed by effective public enlightenment.

This cannot be said of our African setting. We still live in a world where it is believed that a woman delivered by this means has failed in her womanhood responsibility. The fallout of this is that many women who would have had save delivery by this means force themselves through the rigors of labor and vaginal delivery with dire consequences which may include death or severe morbidity on the part of both the mother and the newborn. The mother who undergoes difficult labor stands the chance of losing her baby. Her subsequent reproductive life may become greatly compromised. The risk of developing v.v.f. (vescico-vaginal fistula) is ever present. The risk of maternal mortality is real. On the part of the baby the worst, which is mortality, can occur. If the baby ever survives the prolonged labour assault, then permanent bodily disabilities including brain damage (cerebral palsy) cannot be avoided.

There is therefore a great need on the parts of the various arms of our government to pursue effective enlightenment programme towards educating the general populace about the merits in caesarean section and the hazards associated with refusal when one is indicated.

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