A few years ago, the UK revised the National Health Service (NHS) guidelines for the circumstances under which a woman may have a C-section. A woman under NHS care can now request a C-Section even if there are no medical reasons for it. She need only be made aware of the risks.
The fact that a medical procedure can be requested is the first clue that the risks – either way – are minimal. While the NHS guidelines have no particular bearing on the way that private or public health care is carried out in South Africa, they’re a strong indication there’s not much to distinguish between the end results for you and your baby.
“A C-section is major abdominal surgery,” says gynaecologist Dr Theo Kopenhager. “It’s always better not to unnecessarily open the abdomen. That said, caesarean sections are obviously not particularly risky.”
While the tables for the NHS guidelines show a slightly elevated risk to mothers of post-partum haemorrhage and cardiac arrest, the differences are less than 0.1%. So if a mother is giving birth in a reputable hospital, with an acceptable level of care, she shouldn’t be in any danger.
What is best for baby?
Of course, while most women are concerned for their own bodies, it’s their babies’ health that they’re most worried about. “When I started my training 30 years ago, women frequently endured two to three days of labour, and eventually doctors were happy to see the baby,” says Kopenhager.
“Then, Dr Apgar came along with her health assessment for newborn babies and we started to see a more civilised approach to obstetrics. Bad outcomes were no longer accepted, doctors were blamed and sued, and the decision to take the safer way out by C-Section was made more frequently.”
This meant there was a rise in the number of caesareans when the labour wasn’t progressing well. However, in South Africa, the percentage of C-Sections has climbed close to 70% in private hospitals and over 30% in government hospitals – both well over the World Health Organization guidelines of a 15% C-Section birth rate.
The justification for this type of guideline is an indication for how frequently a caesarean section should be performed to save a baby or a mother’s life. It doesn’t state that women shouldn’t be allowed to choose their birthing method.
But South Africa’s C-Section rate is high, and many women find that their gynaecologist suggests or pressurises them into the procedure when the need for one doesn’t exist. A reputable, experienced gynaecologist won’t put a patient at risk, and will do what he/she believes is the best thing for the mother and baby.
When is it an emergency?
Kopenhager says the following situations call for a C-Section in almost all cases:
- Multiple pregnancy
- Abnormal lie such as transverse or breach
- Foetal distress (decision before or during labour)
- Cephalopelvic disproportion (Where the baby’s head is too large to pass out of the mother’s pelvis)
- More than one previous C-section (decision before labour).
A common reason for ‘emergency’ caesarean is when doctors feel labour is just taking too long. Kopenhager says that the length of labour is not necessarily enough to unconditionally justify a C-section.
“If the baby is doing fine, the cervix is dilating and the head descending, then the labour can continue.”
Many gynaecologists are also reluctant to allow a vaginal birth after a C-Section has been performed in a previous birth. The current guidelines around the world state that two caesareans necessitate a C-section the third time but that a mother can try for a vaginal birth after one previous C-Section. But Kopenhager says there are risks associated with a VBAC (vaginal birth after caesarean) and doctors generally shy away from it.
Doctors will seldom force a woman to have one or another type of birth, but when a woman is pregnant, or in labour, and risks present themselves, it’s wise to listen to your doctor’s advice.
Kopenhager says that a trial of labour – attempting labour when complications exist – is a valid concept and women who feel strongly about giving birth naturally should discuss this with their gynaecologists.
It’s also a good idea to discuss this with your gynaecologist early in your pregnancy so that if you find your expectations don’t match up to their regulations, you can try to find a different doctor.
A vaginal birth versus a C-Section
- Pain during delivery
- Pain in the area between the vagina and anus for up to a few weeks
- Lower incidence of baby being admitted to neonatal ICU
- Baby has lower incidence of breathing problems once born
- Mother usually goes into labour naturally when baby is ready to be born
- Baby usually has better Apgar scores
- The risk of a tear in the vaginal wall or bladder incontinence (most women tear a little, but serious tears occur in only 4% of women)
- An emotional high after having successfully birthed a baby, coupled with exhaustion after all the hard work
- Some women go home immediately, although private hospitals allow up to a three-day stay after birth
- Sexual activity can resume six weeks after birth
- No pain during delivery
- No vaginal pain, but pain in the scar area for up to six weeks, as a C-Section involves major abdominal surgery
- Slightly higher incidence of admission to neonatal ICU (Many C-Sections are performed because the baby’s in distress)
- Baby has slightly higher incidence of respiratory morbidity (short-term)
- Elective C-Sections are scheduled around two weeks before the baby’s due date, which could mean he’s slightly prem
- Baby can have slightly lower Apgar scores, especially at one minute
- The minimal (less than 1%) risk of an infection or heart failure.
- Requires post-operative care
- Most hospitals insist on a three-day stay after a C-Section, particularly after a first delivery
- Sexual activity can resume six weeks after birth