Caesarean Section births high among the poor, say doctors
By Chukwuma Muanya
M EDICAL experts have warned against poor nutrition during pregnancy and child birth to reduce the growing cases of Caesarean Section (CS) births.
About three out of every 10 births in Nigeria are reportedly by this method, through which mothers are delivered by surgical operations.
Medical experts say that most of such operations are conducted because labour failed to progress properly, a direct consequence of poor nutrition. In the developed countries, CS is preponderantly by choice of mothers who want to avoid labour pains.
The chairman of the Medical and Dental Council of Nigeria (MDCN), Dr. Shima K. Gyoh said that the pelvis of the average Nigerian woman is small, owing to poor feeding. This consequently contributes to the rise in CS.
But a consultant obstetrician and gynaecologist based in Lagos, Dr. Chukwunenye Ugochukwu, however, blame health care providers for the development.
The South-West chairman of the Society of Gynaecologists and Obstetricians of Nigeria (SOGON), Prof. Oladapo Ladipo, stated that with proper nutrition from birth, the reproductive ability of the girl child would develop to the optimal level and enhance vaginal delivery.
Similarly, a consultant obstetrician and gynaecologist, Dr. Ralph Omaliko, says that women with high blood acidity levels, whose wombs had failed to contract are prone to CS.
While disclosing that most Nigerian women have tight pelvic bone structures due to poor nutrition, the experts also noted that some mothers prefer the procedure to avoid intense labour pains.
They also noted that there were situations where the operation could not be avoided.
The experts warned that treatments aimed at speeding up labour might induce CS births, but suggested that not giving treatment could allow the womb to rest and regain strength for a vaginal birth.
Gyoh said: " The rate of Caesarean Section is much higher in our environment. This is because of the structure of the skeleton of our people. The baby is developing in the abdomen, but it has to be delivered through the pelvis, which is surrounded by a ring of bones through which the head has to go. If that ring of bones is tight, the head cannot go through. So you have to deliver the baby through the abdomen, which is called CS. If you insist that the head will go down, the baby's head would get stuck and you would lose both baby and mother."
He continued: "If you study the skeletal structure of people, you will find out that people who have been in an area of under or poor nutrition, their bones tend to form a tighter curve. You will notice that the children of the wealthy grow up big, tall with wide pelvis because they have been fed properly from the time of weaning of the breast milk. But the pelvis of the very poor people, who suffer from under nutrition, malnutrition and kwashiokor are different. Their structures are different and tend to be tighter and that is why the rate of CS is high in the country."
Gyoh said that as the standard of living improves, the bones would be bigger and wider, there would be fewer CS births.
"It is unfortunate that some people jump into the conclusion that most doctors are doing frequent CS because of money. It is true some women can come when they are in labour, because of the unending, excruciating pains of contraction, which sometimes last for two days, beg their doctors to please take off the baby through CS. Sometimes the doctor refuses and they have to go on with the labour. Doctors only intervene when it is necessary".
To Ugochukwu, the high incidence is due to the attitude of the health officers. "Many healthcare providers are weary of the hours of work it will take them to conduct one vaginal delivery vis a vis the hours it will take them to carry out CS. If you look at this in Naira and Kobo, you will find out that the hours to do CS are is more rewarding than the hours you will take to deliver a woman vaginally."
He continued: "If a woman, for instance, will take eight hours, 10, sometimes 15 to labour, and she wants her obstetrician to be by her side throughout the process, and when she finally delivers, she wants to pay the obstetrician peanuts, say N20,000, N30,000 whereas if a CS is done by the same obstetrician and releases the woman after two or three hours, higher fees are paid."
Ugochukwu admitted that there were conditions that could necessitate the operation. "There are medical indications for CS where nobody can avoid it. These indications are when the vaginal delivery is not feasible at all. When a woman's pelvis is severely contracted and the bony pelvis is so small that it cannot allow the baby to come out, such a woman must have CS. If the placenta for instance is blocking the passage for the baby to come out, it is incontrovertible that such a woman will have a CS. Also, if a woman that had two or more Caesarean births in the past, most doctors agree that the woman should have her next delivery by CS. Now, if a woman has more than two foetuses in her womb, triplets and above, obstetricians agree that the woman should be offered Caesarean birth delivery", he explained.
Ugochukwu, however, disclosed that vaginal births are much safer than Caesarean Section. He said: "There is clearly a higher incidence of maternal deaths among women who undergo CS than women who have vaginal delivery. The second is what we call morbidity. It is such complications that follow each mode of delivery. Women who undergo Caesarean Section have a higher incidence of infection, they have a higher incidence of post-delivery anaemia, they have a higher incidence of wound complications. A woman who has vaginal delivery, the episectomy (widening of the vagina) rarely gives them much problem."
Ladipo, who is also the President of the Association of Reproductive and Family Health (ARFH), maintained that CS births are inevitable in Nigeria because of the poor nutrition of the girl child, which interferes with her growth and development.
His words: "With proper nutrition from birth, that is balanced diet, the reproductive ability of the girl-child will develop to the optimal level thus encouraging vaginal delivery. Caesareans are now safe operations, and modern medicines mean that women and babies no longer routinely die during childbirth".
Omaliko explained that it has been found that blood acidity levels are highest in women whose wombs had failed to contract and for whom hormone therapy had not worked.
These women, according to him, also had a higher level of lactic acid and a lower level of oxygen in their blood streams than any of the other groups.
"If muscles are working hard but not getting as much oxygen as they need, they change their biochemical make-ups so that they can still perform. This change produces lactic acid. Women who are having difficulty in labour are currently given a synthetic version of the hormone oxytocin to speed up contractions. This often leads to Caesarean Section", he said.`
