22 November 2011
In this era of convenience, a number of women view pain as an unnecessary and avoidable part of childbirth.
Too posh to push, they would rather go under the knife than experience the pain of pushing out a baby.
And, when you look at it critically, this mode of childbirth seems like a good-for-all choice.
The doctor gets a fat cheque, the baby gets out and the mother’s pelvic muscles are not ravaged, as would be the case in a natural birth.
A recent study on the procedure reports that by opting to go under the knife rather than push, you are exposing your baby to a serious respiratory infection.
Babies born through CS are likely to suffer bronchiolitis, which is associated with a 17 per cent increased risk of multiple ailments of the respiratory tract in their first year of life, the study shows.
Although it is often a mild illness, some infants are at risk of a more severe disease that requires hospitalisation.
The study, led by Dr Hannah Moore of Perth’s Telethon Institute for Child Health Research in Australia, says that, while the increase of infection is relatively modest, it highlights the risk to a child’s immune system when elective Caesareans are the chosen birth method.
“We compared elective Caesareans with other modes of delivery because with elective Caesareans we could be confident that labour had not begun and therefore the baby would not have been exposed to (natural) chemicals that are released during the labour process,” Dr Moore said.
“It is increasingly plausible that delivery without labour could impair a newborn’s immune system and may also explain the known link between C-sections and an increased risk of asthma.”
Conditions that increase the risk of severe bronchiolitis include prematurity, prior chronic heart or lung disease, and a weakened immune system due to illness or medications.
These findings are likely to generate a lot of debate in Kenya, where another study by Synovate Kenya carried in 13 urban towns in the month of October reported that 15 per cent of women would rather undergo elective Caesarean than give birth vaginally.
The World Health Organisation officially withdrew its previous recommendation of a 15 per cent C-section rate for all births in June of 2010.
“There is no empirical evidence for an optimum percentage,” the WHO said. “What matters most is that all women who need Caesarean sections receive them.”
Elective Caesarean is normally performed on the basis of obstetrical or medical indication or at the request of the pregnant patient.
In Kenya, the procedure is normally advised when there are complications with the pregnancy and, according to Dr William Obwaka, a gynaecologist, about 10 per cent of mothers opt for elective caesarean section “because they fear normal delivery”.
“There are a number of women who elect this mode of delivery for non-medical reasons, even though we only advise a C-section if we determine that the mother may suffer an anaesthetic complication should she go through a normal delivery,” says Dr Obwaka of Gilead Medical Centre.
Researchers at Perth analysed birth data and hospital records for 212,068 babies over a 10-year period in Western Australia for the study, the first of its kind to link elective Caesareans to respiratory infections.
Bronchiolitis is a common illness of the respiratory tract caused by an infection that affects the tiny airways, called the bronchioles, which lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult.
Kids Health, an online health resource centre, says the first symptoms of bronchiolitis are usually the same as those of a common cold.
They include stuffiness, a runny nose, a mild cough and a mild fever. These normally last a day or two and are followed by worsening of the cough and wheezing (high-pitched whistling noises when exhaling).
“Sometimes more severe respiratory difficulties gradually develop, marked by a rapid, shallow breathing, a rapid heartbeat, drawing in of the neck and chest with each breath — known as retractions — flaring of the nostrils and irritability, with difficulty sleeping and signs of fatigue or lethargy,” adds Kids Health.
Less commonly, babies, especially those born prematurely, may have episodes where they briefly stop breathing (apnea) before developing other symptoms.
The skin sometimes turns blue (cyanosis), which is especially noticeable in the lips and fingernails.
In addition, the child becomes dehydrated from working harder to breathe, vomiting, and taking in less during feedings.
Bronchiolitis has been associated with an increased risk of asthma in children, something that has been linked to elective caesareans in other studies.
Dr Moore said that, when the study commenced in 1996, elected Caesareans accounted for 12 per cent of all Western Australia births.
This increased to 21 per cent in 2005, an average of 16 per cent over the study period.
She said that while most children recover from the infection quickly, it could make the child more prone to other respiratory illnesses later in life.
And Dr Obwaka agrees, adding that Caesarean sections have anaesthesia complications as well.
“The complications experienced during this procedure include drugs given to the mother for anaesthesia during surgery which affect some babies. These medications make the woman numb so she can’t feel pain. But they may cause the baby to be inactive or sluggish,” he says.”Generally, we do not advise women to go through Caesarean Section unless the baby is not lying properly, there is a low-lying placenta, if the baby is too big for passage or the patient has experienced bleeding before pregnancy,” adds Dr Obwaka.
Dr Moore said the research, published in the latest online edition of the international journal Archives of Disease in Childhood, pointed to the need for more research into the suspected role of various chemicals that are produced by mothers during labour in priming a newborn’s immune system.
“Given that Caesarean rates are rising, this potential impact on the immune system might be another factor that parents and doctors may consider if choosing a caesarean for other than medical reasons,” she said.
“As it’s the first time we have reported such an association, it’s really important that the message gets out there that women and their clinicians need to consider this when opting for a caesarean.”
Previous research by the Institute team has found an increased risk of hospital admissions for acute lower respiratory infections in children less than two years of age delivered by elective Caesarean.
A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective.
The risk of placenta accreta, a potentially life-threatening condition, is only 0.13 per cent after two Caesarean sections but increases to 2.13 per cent after four and then to 6.74 per cent after six or more surgeries.
The findings were based on outcomes from 30,132 Caesarean deliveries.
For instance, a normal delivery at the Nairobi Hospital costs Sh95,000 while Caesarean Section costs Sh250,000, minus bed charges and other miscellaneous expenses.
Kenyatta National Hospital charges Sh4,000 for a normal delivery while a Caesarean Section costs Sh8,000, excluding miscellaneous expenses.
“A woman who goes through a C-Section usually takes longer to recover than a woman who has had a vaginal birth, and most of those who have undergone a the procedure should expect to stay for three to four days in the hospital after the procedure,” notes Dr Obwaka.
Full recovery usually takes four to six weeks. Usually, the hospital stay for vaginal birth is two days.