Expert says: Rich women prefer caesarean delivery

Rich women prefer caesarean delivery — Expert

May 20, 2014

 

Consultant Obstetrician/Gynaecologist, Reproductive Health Firm, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Dr. Emeka Ekwuazi

In this interview, with MOTUNRAYO JOEL, a consultant obstetrician/gynaecologist, Reproductive Health Firm, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Dr. Emeka Ekwuazi, speaks about childbirth

What exactly goes on in a woman’s body during child delivery?

The process of childbirth, also known as ‘labour’ is the process by which the foetus is expelled from the womb through the birth canal to the outside world. Understandably, very few life events evoke such complex mix of emotions like the process of childbirth. This process entails a complex interplay of medical, social, cultural and ethical variables than can culminate in a long-lasting physical and emotional impact, which may either be positive or negative. Although a lot is now known about the physiology of childbirth, the exact biological event responsible for initiating the labour process in humans is still unknown. However, an effective labour process to a large extent depends on the efficient interplay of three important factors; the “powers” of the uterus(uterine contractions), the “passages” of the birth canal(the pelvic bones and the soft tissues of the pelvis) and the “passenger” (foetus). Important features in the diagnosis of labour include: regular, painful uterine contractions, occurring at least once every 10 minutes; passage of “show” from the vagina (mucous mixed with some blood); cervical effacement (shortening of the length of the cervix), cervical dilatation; rupture of membrane (water breaks).

When should a woman in labour go to the hospital?

Pregnant women are usually advised to present themselves at a hospital or healthcare centre if they think their water has broken(rupture of membrane) or when the contractions are frequent. There, the diagnosis of labour can be confirmed and their labour will be subsequently managed by skilled healthcare personnel. Although the process of childbirth is a continuous one, it is usually for the purpose of understanding the process and it’s management that it has been divided into three stages: Onset of labour to full cervical dilatation, from full cervical dilatation to the birth of the foetus and from delivery of the foetus until delivery of the placenta.

Although childbirth is a physiological process, despite the fact that a woman may be in labour, complications can occur, hence the recommendation for all pregnant women in labour to attend a health facility where their labour can be attended to by trained medical personnel. The commonest complications of labour include prolonged labour and its attendant complications such as foetal death and vesico-vaginal fistula (involuntary leakage of urine through the vagina), foetal distress, ruptured uterus, and excessive bleeding following childbirth.

The basic principles of managing labour include initial evaluation to ascertain both mother and foetal conditions, continuous monitoring of the progress of labour using partograph, conducing baby’s delivery in a manner that avoids injuries and other complications to both mother and baby, and finally close monitoring of the post-delivery period to ensure early identification and prompt treatment of any complications.

Why is child birth painful?

Pain is one of the defining characteristics of the process of childbirth. Pain threshold varies among women in labour, and appears to be influenced by multiplicity of factors such as cultural perceptions, prior labour experience, fear and anxiety, spousal support during labour, quality of caregiver-parturient relationship. A woman, who has not given birth before, is more likely to experience severe pain than a woman who has given birth more than once. So many factors may contribute to pain in labour, as such; it is difficult to isolate a specific cause. Labour pains can be either physiological or pathological in nature. While contraction pain, cervical dilatation and second stage labour are obviously physiological in nature, severe pain can equally result from pathological causes such as obstructed labour, foetal position, hyper-stimulation, uterine rupture, extreme anxiety and other extant pathology.

Painful impulses during the first stage of labour are mediated at the tenth thoracic and up to the first sacral spinal cord segments, and are largely due to reduced blood supply of the uterus during contraction, as well as dilatation and shortening of the cervix. On the other hand, pain during the second stage of labour is produced by distension, which is the stretching of the second, third and fourth sacral spinal cord segments of the vagina and perineum, with the painful impulses being mediated at (S2 – S4) spinal cord segments.

There are claims that a woman can control the intensity of her labour. How true is this?

It is usually the desire of majority of women to be in control when they are in labour, unfortunately most fail to achieve this goal if or when they cannot cope with the severe pain, hence the ‘screaming of labour’. Thus, it would be prudent to counsel all expectant mothers to have an open mind about pain and its relief and to understand the advantages and disadvantages, benefits and risks of all techniques of pain relief available. Over the past three decades, substantial advances in the quality and safety of obstetric anaesthesia have been made. The option to use pain relief during labour depends largely on the woman’s choice, cultural influence, as well as availability of the expertise.

What can a woman do to prepare for the process?

Firstly, she should plan for both normal birth and anticipating actions needed in case of an emergency. She should ensure that she has access to skilled maternal care, especially during childbirth. This strategy involves identification of the following elements: identifying a skilled birth attendant; identifying the location of the closest appropriate care facility (hospital/maternity homes); gathering funds for birth-related and emergency expenses; making arrangements for transport to a health facility for the birth and obstetric emergency; identifying compatible blood donors in case of emergency.

Vagina tear for first time mothers seems inevitable during child birth, what should they do to aid speedy healing?

They should ensure that they practise good perineal hygiene and perform sitz baths at least twice daily ; the cold sitz baths promotes pain relief by decreasing the stimulation of nerve endings and slowing down nerve conduction. It also reduces swelling, inhibits haematoma formation, and decreases muscle irritability. They could also take pain reliever.

How true is the assumption that more women now opt for caesarean section  rather than normal delivery?

A small but significant number of women are now requesting for caesarean rather than normal vaginal delivery. This demand has been attributed to lack of knowledge and emotional capacity to handle vaginal delivery and its consequences, as well as their desire to preserve their sexual performance. This phenomenon is commoner among the rich and educated women. This has remained a controversial issue in contemporary obstetric practice; on one hand mode of delivery should be a matter of choice, but the question would be is caesarean justified when not medically indicated. Although caesarean is routinely performed nowadays, it is not without potentially severe complications, some of which can result in fatality. Although this phenomenon cannot be totally eradicated, medical practitioners will continue to educate and inform expectant mothers with the best available evidence to enable them make a well informed decision with regards to their mode of delivery.

What are the causes of stillbirth?

The causes of stillbirths are numerous, but generally divided into maternal and foetal causes. Maternal causes include: hypertensive disease, diabetes mellitus, renal disease, obesity, smoking/illicit drug use, advanced maternal age (more than 35 years), thyroid disease, systemic lupus erythematosus. On the other hand, foetal/placental causes includes congenital foetal infections (e.g. syphilis, parvovirus, streptococcal infections etc), congenital structural abnormalities, multiple gestation, chromosomal abnormalities, rhesus isoimmunization, placenta abruption, intrauterine foetal growth restriction.

When is the appropriate time for a nursing mother to start having sexual intercourse with her partner?

Despite a number of inconsistent reports relating to sexual activity for childbirth, most studies however, report on the average, that most couple resume intercourse between five to eight weeks after childbirth. In practice, most practitioners recommend delaying intercourse for six weeks to allow the cervix to close, lochia to stop, and tears to heal. However, the best time depends on when the woman feels she is both emotionally and physically ready to resume intercourse.