In many cultures around the world, vaginal birth is still the norm with women only having C-sections in emergency situations. However, in South Africa, the C-section rate is one of the highest in the world with two in three South African mothers in private hospitals giving birth via C-Section. Researchers believe that this is mainly because C-sections have become elective procedures based on convenience instead of medical necessity – especially in the private sector.
Why are women choosing to have C-sections?
Dr Zeelha Abdool, a consultant obstetrician and gynaecologist at the Steve Biko Academic Hospital believes that a major reason why so many women choose to have an elective C-section is the convenience factor of planning and choosing when to meet their new baby. “For some moms, having the delivery scheduled has considerable appeal, for many reasons. It eliminates the anxiety, stress and uncertainty of the onset and duration of labour, as well as the repeated vaginal examinations needed with a vaginal delivery. Most C-sections are performed under spinal anaesthetic, and the procedure is pain-free,” she adds. This alarming trend towards having an elective C-section might mean that healthy pregnant women who would otherwise be able to have a vaginal birth are choosing to have a C-section because it’s the “new norm”.
But is a C-section really necessary? We look at a few common incidences where gynaecologists usually recommend a C-section.
If your gynaecologist picks up any issues with your placenta, and it’s failing to nourish your baby as it should, you’ll more than likely need a C-section. In this case, it would be an emergency and not a scheduled operation, says certified doula and midwife Magdeleen Moller.
Conditions like placenta previa (where the placenta is low lying) is a valid reason to have a C-section as this could be very dangerous during birth. Placenta calcification, where the placenta is maturing at a rapid rate, also needs to be checked regularly to ensure that it’s not compromising your baby’s growth and development.
According to the American Pregnancy Association, placental abruption (where the placenta separates from the uterine lining), is another issue that needs to be monitored carefully as it can disrupt the flow of oxygen and nutrients to your baby.
If you’re experiencing any of these symptoms during pregnancy, you’ll need to see your healthcare provider immediately;
- Rapid contractions
- Vaginal bleeding
- Stomach pain
- Uterine tenderness
You’re having twins
While it is possible to have a natural birth with twins, many gynaecologists won’t want to take the risk of delivering multiples naturally, so your gynae might insist you have a C-section.
There are also a few complications with multiple pregnancies that may give rise to having a C-section. These include:
- Preterm labour
- Low birth weight
- Gestational diabetes
- Placental abruption
- Intrauterine growth restriction (IUGR).
No doctor can force you to have a scheduled C-section if you’re having a healthy multiple pregnancy, says Magdeleen. “However, if your doctor strongly suggests it, I think it’s important to wait for your body to go into natural labour and then proceed with the C-section as this will prepare your babies for life outside the womb and your body for breastfeeding,” she adds.
A possible medical emergency
You might have heard that if the umbilical cord is near or close to your baby’s neck, you’ll need to have an emergency C-section, but this isn’t necessarily the case, says Magdeleen. Your gynae will first need to assess the risk and check the blood flow in the umbilical cord, as well as check your baby’s heart rate. Only if there is a distinct problem and your baby is in distress will you need to have an emergency C-section. If you’re in your third trimester, it’s always a good idea to monitor your baby’s movement and count the kicks as it will help you pick up any changes.
According to the American Pregnancy Association, setting aside time every day when you know your baby is active to count kicks, swishes, rolls, and jabs may help identify potential problems and can help prevent stillbirth. Ideally, you want to feel at least 10 movements in two hours.
Magdeleen says you should be prepared to go under the knife for the following reasons:
- If your baby is in distress
- If your baby is too big to pass through the vaginal canal
- Failure to progress during labour (this can cause your baby to go into distress and might put you at risk of further complications, too)
- Unsuccessful turning or a breech baby
- If you’re pregnant with triplets or more
- Uterine rupture (happens in less than 3% of mothers)
- You have an infection like genital herpes or HIV
- If your baby has a type of birth defect that changes the shape or size of the body.