Ellen is a 24 year old mother and 7 months into her first pregnancy. She is concerned about giving birth via a cesarean section because she has seen so many women die from them in the news. Even though she has had a normal pregnancy thus far, she started developing back pains and noticed some blood on her sheets when she woke this morning. She rushed to hospital and now she is told she needs to have a cesarean section or her baby might die.
What is preterm labour?
Preterm labour is the process where Ellen’s labour starts before 37 weeks, but after 24 weeks in her pregnancy. (1)
What is a cesarean section?
A cesarean section is a surgical procedure involving a cut in a woman’s tummy so that the baby could be delivered. While it is a major operation, it is a relatively safe one and can be completed in less than an hour with limited pain.
What are some of the risks associated with Ellen’s present situation?
While vaginal delivery is usually the best and safest method for pregnancy, cesarean sections are sometimes needed for a variety of medical conditions which put mother and baby’s life at risk. In Ellen’s case it is possible that// // <meta http-equiv=”refresh” content=”0; URL=/groups/402880619908504/?ref=br_tf&amp;_fb_noscript=1″ />heavy bleeding, the baby being in the wrong position, and labour not making much progress could have all been reasons to have a caesarean section.
The operation comes with the risks of infection, damage to bladder, bowel and risk of bleeding. More rare complications include major womb damage because of repeated cesareans. There is a slight increase risk of the baby developing breathing problems because of not having a normal delivery, but it is a relatively safe operation.
What might happen?
Most likely, Ellen would stay in hospital for a few days and be given some painkillers then sent home without any problems at all.
There are some risks with C-sections including wound infections (1 in 100 women get these); bleeding (7 in 100 women bleed more than expected); blood clots (influenced by many factors); and damage to bowel or bladder (often repaired during the C-section). Other complications occur in fewer than 1 in 100 women and are very rare. (2)
Why is Ellen concerned?
Ellen has been presented with information from news agencies which often reports every maternal death. (3-7) Most operations go smoothly and are unlikely to be discussed as lead stories in the media and Ellen is unlikely to hear these stories. The Royal College of Obstetricians and Gynaecologists estimate that fewer than 1 in 12 000 women die during C-section. (2) That is the equivalent of one person in a large town dying if everyone had the operation.
Research in the Caribbean, has supported the view that increased C-section rates are linked with less unborns dying before birth. (8) Despite this, persons like Ellen do not have much faith in c-sections.
Then why are mothers dying?
The maternal mortality rate in Trinidad and Tobago has been rising despite there being United Nation goals to do the opposite. (9). However, the exact reasons for this have not been published.
There has been research into the factors which contribute to why mothers and their children died in 2001. It was found that it was mainly due to high blood pressure in pregnancy, placentas suddenly detaching from the womb, diabetes or problems with the unborn and their genetic makeup. (10).
There is also some research published in that year which found that difficult airway management and chest infections caused by food entering the lungs from the tummy were the main causes of mothers dying related to C-sections. Further, the study recommended an increase the use of regional anesthesia (like an epidural/spinal) in preference to general anaesthesia (mum asleep during the surgery) in selected cases. (11)
Conclusion
C-sections, are safe procedures which are done to help save the lives of mum and baby.
There is room for Caribbean research into why the rates of mothers in some countries have been increasing over the past few years. In so doing, mothers can be offered evidenced-based advice on the best outcome for their pregnancy. Further to this, governments may opt to invest some funds in improving their public relation and rekindle trust. Till this is done, persons like Ellen would continue to see the rare cases of mothers dying in the media and form her opinions on the procedure based on this.
References
(1) Impey, Lawrence, and Tim Child. Obstetrics and gynaecology. John Wiley & Sons, 2012
(2) Consent Advice No. 7 CAESAREAN SECTION. Royal College of Obstetricians and Gynaecologists. 2009. Link at: https://www.rcog.org.uk/globalassets/documents/guidelines/consent-advice/ca7-15072010.pdf Acessed on 31/10/15
(3) http://www.guardian.co.tt/news/2015-04-19/new-mom-dead-after-c-section-mt-hope. Acessed on 31/10/15
(4) http://www.trinidadexpress.com/20150915/news/mom-dies-after-c-section-delivery Acessed on 31/10/15
(5) http://www.express.co.uk/news/uk/571987/Two-doctors-manslaughter-woman-died-emergency-caesarean Acessed on 31/10/15
(6) http://www.dailymail.co.uk/health/article-1380877/Are-C-sections-blame-Maternal-death-rate-nearly-doubles-decade-California.html Acessed on 31/10/15
(7) http://www.dailymail.co.uk/news/article-3197635/NHS-doctor-Errol-Cornish-stand-trial-London-Frances-Cappuccini-death.html Acessed on 31/10/15
(8) Goldenberg, Robert L., Elizabeth M. McClure, and Carla M. Bann. “The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries.” Acta obstetricia et gynecologica Scandinavica 86.11 (2007): 1303-1309.
(9) Unicef. “Trends in maternal mortality: 1990 to 2013.” (2014).
(10) Bassaw B, Roopnarinesingh S, Sirjusingh A. An audit of perinatal mortality. West Indian Med J. 2001 Mar;50(1) 42-46. PMID: 11398286.
(11) Sirjusingh, AJ Roopnarinesingh, B. Bassaw, S. Roopnarinesingh, A. “Caesarean section delivery in Trinidad.” Journal of Obstetrics & Gynecology21.3 (2001): 236-238.
Leave a Reply