Pros and Cons of C-Section deliveries

Maternal care

In certain instances the mother comes with heavy bleeding and in order to save the mother’s life we have to go in for a C-section delivery.

Motherhood is one of the biggest milestones in the life of any female. Those 40 weeks of labour pains, body mass gains and other complications are borne with love and courage for the sake of the baby to be born. But at the time of delivery there may be certain complications which might have a risk on the life of the mother or baby or on the lives of both. Therefore normal deliveries may not always take place although it has less risks and complications post-delivery. In this case a Caesarean delivery, also known as C-section delivery, is recommended. April has been officially named as the Caesarean Awareness Month and changing trends show that young mothers request for C-section deliveries with changing attitudes towards pain and other circumstances. Speaking to Health Capsule, Dr. Sanath Lanerolle, Consultant Obstetrician and Gynaecologist explained the instances in which a C-section is required, its risks and complications and how a mother should take care during
post-delivery.   

What is a C-section?

A C-section is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. This is often necessary when a vaginal delivery would expose the baby or mother to risk. A C-section delivery may be performed based upon the shape of the mother’s pelvis or history of a previous C-section. The World Health Organisation (WHO) recommends that Caesarean section should be performed only if  medically necessary. Some C-sections are also performed at the request of the mother as well.   

There are requests for C-section deliveries at present because it is less painful. But now we can perform a totally pain-free normal delivery provided that there is a trained anesthetist. That is another challenge that -we face because we don’t have many trained anesthetists to perform this task

When is it required?

According to Dr. Lanerolle there are two occasions during which a mother requires a C-section delivery. “One is during emergencies which may arise due to a requirement of the mother or the baby. In certain instances if the baby’s heart is going to stop or if the baby’s life is in danger we do C-section to salvage the baby. If the maternal life is in danger, for example if the baby gets stuck during a normal delivery, we have to do a C-section. In certain instances the mother comes with heavy bleeding and in order to save the mother’s life we have to go in for a C-section delivery. Certain causes are elective where we predetermine that either the mother or baby cannot withstand the stress of labour. It could also be that going in for a normal delivery could have a risk on the baby as well as the maternal life,”said Dr, Lanerolle.

Some other common complications associated with the maternal side are as follows ;   

• Narrow pelvis   
• Placenta previa – where the placenta covers the birth passage   
• More than two Caesarean deliveries   
• More than one foetus   
• Cardiac diseases   

Several risks may be associated with the baby as well. These include ;   

• Breech birth   
• Large babies (weighing more than four kilos)   

Risks and complications

There are immediate, intermediate and long term risks. Immediate risks are high when you’re doing an emergency C-section delivery when compared to a planned and elective case.   

A C-section delivery may be performed based upon the shape of the mother’s pelvis or history of a previous C-section

Immediate risks

• Post-partum haemorrhage – Bleeding occurs during the C-section or during the first 24 hours of the delivery (the second most common cause of maternal deaths in Sri Lanka)   
• Damage to the bowel and bladder
• Blood transfusions – When bleeding occurs a massive blood transfusion needs to be done which will be between 20-30 pints on average. Sometimes the blood may contain HIV and Hepatitis B if not properly screened.   
• Blood clots – These form in the legs but could be propogated to the lungs and cause immediate death also known as Deep Vein Thrombosis (DVT).   
• Amniotic fluid embolism – The foetus is in the water (amniotic fluid) and if it goes into the maternal system it would cause immediate death.   
• Morbidly adherent placenta – This is a condition where the placenta has gone through the uterus and has come through the bladder and sometimes to the abdominal wall. This condition occurs during second and third C-sections.   

Intermediate risks

Infections – This could be in the wound site or in the pelvis also known as pelvic sepsis which is another cause of maternal deaths in Sri Lanka.   

Long term risks

• After three C-sections it is not safe to do the fourth   
• Number of children may be limited   
• Infections may lead to infertility   

“Normal births are always better, but the risk for the baby is a bit higher than a C-section delivery, but in the case of the mother it is always good to have a normal delivery,” Dr. Lanerolle further explained. “There are requests for C-section deliveries at present because it is less painful. But now we can perform a totally pain-free normal delivery provided that there is a trained anesthetist. That is another challenge that -we face because we don’t have many trained anesthetists to perform this task,”said the doctor.

After care

• Pain management – Could be done with injections and medicines   
• Early mobilization – During uncomplicated C-section deliveries where mother can eat and drink in order to relieve the blood clots   
• Drink plenty of water – To reduce risks of blood clots, smooth passage of stools and to avoid urine infections   
• Personal hygiene –Daily baths are required and the wound needs to be cleaned and dried to avoid the risk of infections   
• Bowel problems and constipation – Eat as many fruits, green leaves and vegetables as possible   
• Anal and Urine incontinence – This occurs in mothers who have gone through an emergency C-section.   
• Breastfeed immediately after the C-section is done
• Wound care – Do not apply any dressings or cream. Absorbable sutures are used. Therefore keep it dry and allow it to heal.   

In his concluding remarks Dr. Lanerolle said that one should be pre-conditioned for a normal labour and the attitude towards pain needs to change. “Therefore one need not worry about the pain. If pregnancy is properly managed you need to prepare for labour from the beginning. The mother needs to be informed. Mothers should be empowered. They also need to do some physical and breathing exercises along with a few pelvic flow exercises which will help to deal with the pain. During delivery the mother will be able to push the baby out. Most of the time mothers cannot push strongly and therefore we wold have to use the forceps and vacuum. They should also know that there are painkillers. Epidural analgesia is available for them to have a pain-free labour,”he said.