A couple of days ago I received a call from *Patrick. Patrick, a husband, was calling about his wife who was pregnant with their second child. The wife's obstetrician had suggested a Caesarean section delivery, but she was reluctant to go along with the plan.

She felt that delivering vaginally would make her “feel more like a mother” and was struggling to come to terms with having another surgery. Despite advances in obstetric care, misconceptions about childbirth persist. Caesarean delivery is one of the most common and safe surgical procedures performed.

Misconceptions

Myths about childbirth are often based on beliefs held by friends and family members rather than factual information. Many women feel pressure from society that vaginal delivery is the only way to truly become a mother. It is perceived by many as a rite of passage. In many cultures, giving birth vaginally is associated with womanhood, stamina or strength.

Women who deliver vaginally are praised for “having birth naturally”, while those who require surgery are made to feel as though their bodies have failed them in some way. Some women are even told that they took the easy way out or that they did not truly give birth. These statements can leave women feeling guilty, disappointed or ashamed even after they have undergone major abdominal surgery to deliver their babies.

Social media influence

Celebrities and influencers have also perpetuated the vaginal birth as an ideal type of birth on social media. There is little discussion about the unpredictability of pregnancy and labour or the possibility of medical complications in healthy women. Therefore, many women are so afraid of having a C-section that they will avoid seeking care late or refuse recommended treatment, putting their own health and the health of their babies at risk.

Contrary to popular belief, a decision to deliver by C-section is not a sign of failure nor is it the easy way out. It is the deliberate interruption of labour through surgery because continuing labour or delivering vaginally could result in harm to mother or baby. Recovery from C-section takes longer than recovery from vaginal delivery.

Women who deliver by Caesarean section experience postoperative pain and endure risks associated with major surgery. A C-section is not performed because women are incapable of giving birth but because it is the safest option under the circumstances.

Why C-section birth?

There are many reasons why a Caesarean section is recommended. One, the position of the baby may cause concern. The baby may be breech (buttocks presenting first) or lying sideways (transverse lie). Both of these presentations make vaginal delivery impossible. Sometimes labour does not progress even with strong contractions. If the baby’s heart rate shows evidence of fetal distress, an urgent delivery may be recommended.

Certain placental conditions affect how safely you can deliver vaginally. Placenta praevia is a condition where the placenta covers the cervix. This blocks the baby’s exit route. Premature separation of the placenta from the wall of the uterus can cause severe bleeding. Serious hypertension, preeclampsia and eclampsia also warrant urgent delivery. Some multiple pregnancies, large babies, abnormal uterus and maternal infections may also increase the need for Caesarean deliveries.

Your previous pregnancies may also influence your OB’s recommendation. Just because you have had a previous Caesarean section, it doesn’t mean that all your deliveries must be by surgery. If you had a previous Caesarean section because you had a breech baby, twins or foetal distress and these are not present in your current pregnancy, you may be able to deliver vaginally. This is commonly known as a vaginal birth after Caesarean or VBAC.

Vaginal birth after C-section

Women with previous two or more Caesarean sections, certain uterine incisions, previous uterine rupture or a condition that prevented you from delivering vaginally before may be advised to repeat a Caesarean section. Pregnancy complications can also influence this decision. Ultimately, the recommendation should be personalised for your specific situation by your obstetrician.

Because of the risk of uterine rupture, women attempting VBAC need to labour at a facility that can perform continuous foetal monitoring, conduct emergency Caesarean deliveries and has blood for transfusion should it be needed. Access to emergency surgical and anaesthesia services should be available. Women should never attempt VBAC where these services are not available.

There are some signs during labour that should prompt immediate medical attention. Severe abdominal pain that does not stop after each contraction. This could be a sign that your uterine scar is separating. Vaginal bleeding, a sudden decrease in the strength of contractions or stopping of contractions. If you experience signs of shock such as feeling faint, sweaty, pale, weak, dizzy rapid pulse or collapse, you should seek immediate medical assistance. These conditions will not always mean you have ruptured your uterus, but they should be checked by a medical professional immediately.

Motherhood is not defined by the route through which a baby enters the world. It is defined by the care, love and commitment a woman gives to her child.

Follow our WhatsApp channel for breaking news updates and more stories like this.

Dr Bosire is a medical doctor and lawyer. stebosi51@gmail.com