Many women in India are opting for an operative delivery or caesarean section. This trend is reflected in national statistics, with a caesarean rate of seven per cent in rural areas, 60 per cent in urban areas, rising to almost 80 per cent in private hospitals, many of which offer “package deals”.
Many mothers, especially if they are well off, do not want the pain or the hassle of natural birth, they feel they might lose their figures, they feel “out of control” in labour or are simply “too posh to push”. They are carried away by the fact that Victoria Beckam and Brittany Spear delivered by caesarean section. They forget other icons, such as Princess Diana and Aishwarya Rai Bachan who had normal deliveries.
Caesarians are not surgeries to be performed on demand. The Federation of Obstetric and Gynaecological Societies of India (FOGSI) has listed the criteria and recommendations for caesareans. If these are strictly followed, fewer than 15 per cent of pregnancies would actually require a caesarean delivery.
There are relatively few conditions in which a normal vaginal delivery is not feasible. There may be previous scars on the uterus (owing to earlier classical caesareans or other surgery), the placenta may be located across the opening of the cervix or if there are certain infections of the vaginal area. Relative indications are large babies, multiple births (twins, triplets), abnormal position of the baby, illnesses (such as hypertension) in the mother, failure to progress while in labour and a falling fetal heart rate.
When the rising trend of caesareans was studied, it was found that the reason for surgery was not always medical. The maximum number of operations took place on weekdays during office hours. The time and date were often decided by the patient and family members for personal reasons, like convenience, career constraints or even a relative who wished to see the baby. Parents wanted auspicious, convenient or unique birth dates for their children. This year 12.12.2012 fitted the bill. (The day was overbooked in hospitals for caesareans) After all, it will be another 1000 years before 1.01.01 rolls around!
The baby may be ready for birth anywhere from the 37th to the 42nd week, at which time the symptoms of child birth usually occur normally. In a planned caesarean (as opposed to an emergency caesarean because of complications in labour) the date and time are fixed. Sedation and anaesthesia administered to the mother can cross over the placenta to the baby. The baby may not breathe spontaneously immediately after birth and require resuscitation. Also, as the mother is alert soon after a natural birth, and does not have a painful abdominal scar, she is able to feed the baby immediately. Lactation is rapidly and efficiently established.
Pain felt in the course of a natural delivery is time bound and recovery is rapid. In the case of caesareans, pain (particularly backache after spinal anaesthesia ) may persist for days, months or even years.
All surgery is to be taken seriously and can have complications. A caesarean is a major abdominal surgery and can have complications such as bleeding, infection, keloidal scarring or urinary tract injury or infection or adverse reactions to medications and anaesthesia.
There is no magic pill for a normal delivery. To improve your chances:
• Maintain a BMI (weight divided by height in metre squared) of 23.
• Exercise actively before pregnancy for an hour a day by jogging, running, swimming or cycling.
• Once pregnant, walk briskly for 30 minutes in the morning and 30 minutes in the evening.
• Drink three litres of water a day.
• Join antenatal exercise classes to keep your body flexible. It will also teach you to breathe correctly so that you can push out the baby efficiently.
• Oil your body regularly, particularly the pelvic area, so that it is elastic and stretches easily.
Choose your hospital carefully. Check the statistics to see the number of deliveries that are caesareans. It should not be more than 15-20 per cent. See if there is more than one obstetrician on call and if they have a rotation or duty schedule. It is not physically possible for a single person to attend outpatients, do planned surgeries and conduct deliveries without the two Rs, rest and recreation. Normal labour may take up to 12-16 hours. The doctor should be willing to wait and give you a chance.
The pain can be helped with mild sedation, deep breathing, epidural anaesthesia or intermittent administration of a mixture of 50 per cent nitrous oxide and 50 per cent oxygen.
Childbirth is a natural process, which has occurred through centuries. It is better for mother and child if we try to keep it that way!
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at email@example.com