To ‘c’ or not to ‘c’

Saturday, 03 November 2007
By Kholood F. Al-Rhamah

It used to be that birth by C-section was reserved for situations of life and death, either for the child or the mother, or both. These days, however, young mothers-to-be are opting for the surgical procedure rather than endure the agonizing pain of natural childbirth.

What's changed?
First off, let's take a look at the procedure.

What is a C-section?
A C-section or Caesarean Section is a birthing procedure in which a doctor surgically makes an opening in the uterus wall in order to extract the baby manually, bypassing vaginal delivery.

Why go the C-section route?
Reasons behind C-sections can be either psychological or physical or even both. Dr. Hassan Abduljabbar, Professor of Obstetric & Gynecology at the United Doctors Hospital in Jeddah, said "The lack of sufficient time on the part of hospital staff to prepare the pregnant women psychologically is not beneficial in allaying a young woman's fear of the pain of childbirth.

Especially in light of the influence of stories that she has been hearing from family and friends about natural childbirth. She's full of misconceptions and naturally wants the simplest and least painful way out - and that's a C-section."

C-sections not only minimize the pain associated with childbirth, they can be scheduled just like any other surgery, a real advantage over the 3 A.M. drive to the maternity ward.
Dr. Hassan added, "We don't have sufficient statistics in Saudi Arabia to determine the actual percentage of women who choose C-sections over those who have no choice."

Clearly, opting for such a procedure requires a full understanding of the advantages and disadvantages of the procedure and serious discussion with one's doctor. All things being equal, the risks in C-sections are extremely low.

Do twins necessitate a C-section?
There's no validity, at all, to the myth that twins are by necessity delivered via C-section. It really all depends on how the babies have come to rest in the uterus. If their heads are both pointed downward prepared for natural birth, then there's no need to resort to a C-section. If one of the twins is not in optimal position, however, a C-section is usually employed for delivery.

Another misconception is that a woman is unable to delivery naturally after having a C-section.
"If the mother gave birth with a C-section, her chances of giving birth naturally the second time is almost 70 percent if there are no medical reasons preventing that. But most women don't realize that and they automatically choose the c-section" said Dr. Abduljabbar.

Prof. Ezz Eldine Azzam, a consultant in obstetrics and gynecology at the Saudi German Hospital in Jeddah affirmed that a C-section does not impair the ability to have a natural birth later. "As long as there is no medical reason to force the mother to have a c-section in the future, then the possibility exists but always under constant medical supervision" Said Dr. Azzam.

Personal experience?
Amal is a 35 year old mother of six children whose last two children were delivered by C-section. Amal got married when she was almost 18 years old and had her first three children in the first 4 years of her marriage. She became pregnant with her fourth child when she was 26 years old, and found herself frightened of the impending birth.

"It felt like the past five years had been 50 and I couldn't imagine going through the pain of delivery again," Amal said.

Although she was in good shape and perfect health when her doctor examined her in her seventh month, she had already decided that she wanted a C-section. The doctor explained that she didn't really need one but Amal insisted.

"My fear of the pain and the whole process prevented me from having a natural birth despite the doctor's warnings," she said.

Two years later, Amal had her sixth child. Delivery was also via C-section, but this time the doctors mandated it.

"I entered my last month waiting for my delivery. When the contractions started, they were very close together. I spent about five hours in labor but when the doctor examined me he decided that he would have to do a C-section," Amal continued. She had not dilated sufficiently for a safe natural delivery and the doctor feared for the baby's life.

How is recovering from a C-section?
Requirements following a C-section are pretty standard. The mother usually starts drinking liquids only after 6 hours. She can resume eating after 12 hours, and start moving around the second day. She can breastfeed as soon as she's comfortable and she's likely to check out of the hospital after a three-day stay.