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Normal or caesarean?
A Caesarean section may result in a compromise in the mother-child bonding

“Why did you have a normal delivery with so much pain? A caesarean is so much better and easier.” A common inconsiderate comment to a new mother, that requires an adequate and appropriate knowledgeable response.

The arrival of a baby should be a happy event awaited with joyful anticipation. Pregnancy is, after all, not a disease. It is a normal part of the cycle of birth and death. It is nature’s way of propagating the species. As for the “unbearable” pain of labour, it only appears to last forever. Once the delivery is over, the pain is gone and the mother is back to normal.

In ancient Indian manuscripts and in Egyptian mythology, there are records of disruption in the sequence of events of child birth. The child sometimes refused to come out. It got stuck in the uterus, posing grave danger to the life of the mother and baby. Ancient physicians learnt to cut open the uterus, saving the life of the baby. Under Roman law (a decree of Caesar), operations were compulsorily performed on women dying during child birth to save the life of the unborn baby. With no anaesthesia, suture materials or aseptic surgical techniques, the women did not survive this procedure. Contrary to popular perception, Julius Caesar was not born in this manner.

In the 1900s only 10 per cent of women had caesareans. Now with better medical care, greater awareness and the adoption of the small family norm, the incidence has been steadily increasing. Some 25-40 per cent of the pregnancies today end up as caesarean sections. In affluent urban areas as many as 50 per cent of the deliveries are caesareans. Many women opt for a caesarean and demand it from their obstetrician. They are anxious, fearful of the outcome of the pregnancy or unwilling to attempt the process of normal labour. They are even willing to pay to have an elective caesarean section at an auspicious time and day, convenient for both the doctor and patient.

Caesareans are needed if

Labour does not progress satisfactorily, an attempt at normal labour has failed and the baby’s life is in danger.

The position of the baby is abnormal (breech or transverse).

There are multiple babies (twins or triplets).

There is a disproportion between the size of the baby and that of the mother (a large baby and mother with a small pelvis).

The mother is an older woman.

She has conceived the baby after intervention (test tube babies).

The mother has a medical condition complicating the pregnancy.

Caesareans are fast and easy, but they are a major surgical procedure involving anaesthesia and opening up of the abdomen. Maternal mortality in the best of hands varies from 0.5 per cent to 3 per cent.

There may be other complications after the surgery, which may or may not be fatal. There may be excessive loss of blood. The uterus may fail to contract after the operation. Infection may occur in the wound. There may be clot formation in the legs, leading to dangerous or fatal pulmonary embolism.

In an elective caesarean, where the time and place are preset, the baby may not be ready to be born. Spontaneous breathing may not occur and resuscitation may be required. Soon after the surgery, the mother may be sedated for relief from pain. There may be IV lines in her arms and a catheter to collect the urine. The abdomen has sutures and is bandaged. All these pose physical impediments to breast feeding. Of course, some strongly motivated women still manage to exclusively breast feed the new-born baby. In others, lactation is never satisfactorily established. Very soon the baby is artificially fed with cow’s milk or tinned formula milk. The child’s health and immunity suffer. The physical presence of the mother is not required for sustenance (anyone can feed the baby). As a result, mother and baby bonding may be compromised.

After a caesarean (elective or necessary) section, the new mother is often horrified by her waistline. With the surgical procedure, exercises to regain muscle tone and to lose weight may be delayed. Actually today studies have shown that anaerobic exercises to a count of 20 for tightening the abdominal muscles and slow walking can be started only about two weeks after the surgery.

It is easier to have a caesarean today than it is to have a normal vaginal delivery. However, even if the first delivery has been a caesarean, the second can be normal, provided the indication for the first operation is a non-recurrent condition.

If you want to attempt a normal vaginal delivery, when you choose your hospital and physician, check the statistics of normal deliveries versus caesarean at that centre. Also, walking for 40 minutes in the morning and evening during pregnancy keeps the mother physically fit, builds her endurance and goes a long way towards ensuring a normal outcome.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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