Fear, vanity, Victoria Beckham – blame what or who you like, but elective Caesarean sections are more popular now than ever before. Sceptics would have us condemn this as a selfish – and unnecessary – threat to the baby’s health, but is this really the case? There are dangers in all types of childbirth, be it vaginal or through surgery, but it’s now got to the point where there’s so much scaremongering out there, it can be difficult to see the wood for the trees.
‘I’ve been doing this job for 18 years and the amount of Caesareans being performed has undoubtedly gone up,’ says Dr Ibrahim Abd Elrahman, a specialist in obstetrics and gynaecology at The City Hospital. ‘I’d say we’re heading towards about 25 to 30 per cent of births in the UAE being done by Caesarean section.’ To set this in context, the rate in the US is almost one in three, while some regions of Italy report a Caesarean rate of 90 per cent. The World Health Organisation (WHO) recommends that the rate should not exceed 15 per cent in any country.
Other than in extreme cases like Italy, most C-sections are performed for health reasons. Often, these do not become apparent until labour has started, in which case an emergency operation is performed. However, there are also non-emergency medical circumstances under which a Caesarean is generally recommended by obstetricians: when the baby is breech (ie set to come out feet, rather than head, first), if there’s a family history of problematic childbirth, or if the mother has had previous birth or post-birth complications. But although medical factors account for the greatest proportion of Caesareans, around a tenth of Caesareans in the UAE are part of a well-documented trend emerging for women to choose not to give birth naturally for non-medical reasons.
Upon hearing this, most of us probably picture a bimbo scheduling in her hospital appointment between lunches and manicures. The media have dubbed this stereotype ‘too posh to push’ – perhaps unsurprisingly, given that celebrities such as Victoria ‘Posh Spice’ Beckham have played a part in popularising the practice (although Beckham’s Caesareans are actually said to have been for medical reasons). However, most women considering having an elective C-section would argue that it has nothing to do with how posh they are; the real reason is far simpler than that: fear.
Despite the fact that women have been giving birth since, well, the beginning of the human race, pushing a baby through a hole which seems so very, very small still seems pretty unnatural to many (apparently, size-wise, it’s the equivalent of a man pushing a tennis ball through his urethra – ouch). OK, so women have a handy elasticity which men lack, but that still doesn’t go far in assuaging the absolute terror many of us feel when considering the concept. Horror stories from friends who are ‘only trying to help’ just make matters worse.
The anti-C-section brigade would have us believe a natural childbirth is the only safe option, and the prevailing discourse is that Caesareans should be viewed as a last resort rather than a lifestyle choice, but vaginal deliveries are not without their risks either. Dr Ibrahim says these can be split into those to mother and those to baby. ‘Some of the biggest risks – and these are still rare – are tearing of the uterus during delivery, infection, and heavy bleeding,’ he explains. ‘There are also problems that can occur after the birth: if there is tearing of the perineum during labour, this can sometimes heal improperly, resulting in possible later problems with intercourse. Women can also suffer prolapse, whereby the uterus drops.
One of the side-effects of this can be urinary incontinence, but prolapse can often be helped with physiotherapy or, if that doesn’t work, surgery.’ Dr Ibrahim goes on to explain that prolapse is actually possible with any pregnancy; natural childbirth merely increases the risk, but it is not a life-threatening problem and, as such, many women just get on with things and never report it to their doctor.
Babies also face dangers during a vaginal delivery – after all, it’s a pretty adventure-packed journey. These could include anything from a failure to progress during an attempted vaginal delivery, to foetal distress (eg an abnormal heartbeat), to umbilical cord complications (for instance, the cord becoming entangled with the baby and interfering with its air supply).
With all these factors weighing on expecting mothers’ minds, it’s hardly surprising that so many people consider having a C-section. But guess what? Caesareans aren’t a failsafe solution either: they, too, carry risks. ‘There are three key dangers with a Caesarean section because it’s an operation,’ explains Dr Ibrahim. Firstly, anaesthetic is involved. Although it is usually only a regional anaesthetic, it still carries very unusual, but nevertheless serious, risks – one of which is causing the baby to struggle to breathe due to fluid not being fully expelled from the lungs. Babies delivered via C-section are also 20 per cent more likely to suffer from diabetes.
The second major danger is the fact that a Caesarean is a surgical procedure, and as we all know from watching Grey’s Anatomy, these don’t always go smoothly. However, as Dr Ibrahim points out, with a quarter of all births being done via C-section nowadays, surgeons are experienced enough for these risks to be extremely low. Despite this, though, it is a major operation and as such requires more recovery time than a vaginal delivery, meaning the mother is less able to move around for the first few weeks. Some people believe that this can make it more difficult for mum and baby to bond.
Finally, the mother’s health, as well as future pregnancies, can be affected: if a woman had a Caesarean for her first birth, some doctors recommend repeating this for the second pregnancy in case the scar on the uterus splits from the pressure of contractions. There is actually only about 0.5 per cent chance of this happening first time round, but this statistic increases in line with the amount of Caesareans a woman has had.
There are fears that doctors sometimes unnecessarily pedal Caesareans as an option because they can make more money while spending less time on the procedure (at The City Hospital, a natural birth starts from Dhs11,000 while the starting price for a Casaerean section is Dhs15,000). Added to this is the ever-present fear in doctors’ hearts of malpractice lawsuits if something goes wrong during a natural delivery: Dr Ibrahim says a study in the UK showed that this factor played a part in around one in five decisions to go ahead with a C-section. ‘I’m not saying it’s right, but in this day and age this factor is something that can’t be avoided,’ he says.
One myth that can be traced directly back to the ‘too posh to push’ camp, and one which Dr Ibrahim is at pains to dispel, is that having a Caesarean section at 39 weeks can mean that the mother avoids getting stretch marks. ‘You can get stretch marks well before 39 weeks,’ he exclaims. ‘The abdomen stretches during the entire pregnancy, and in the final week the baby’s growth is not fantastic. The idea that having a section at 39 weeks will prevent stretch marks is unlikely to be true; I’ve certainly seen no evidence of that.’ Nice try, Hollywood.
So, are we damned if we do, damned if we don’t? Not at all, says Dr Ibrahim. The dangers are slim in all situations; the key intention of doctors when outlining these risks is to ensure that their patients are fully informed. ‘If a woman’s obstetrician explains the pros and cons on both sides, they should be free to make their own choice,’ he says. ‘It’s a tough decision to make and one I’m glad I’ll never have to make myself.’ Alright for some.
Dr Ibrahim practises at The City Hospital (800 843 2489).
Here’s what you can expect during the recovery period from a Caesarean.
We’re not going to lie: you’ll be in a lot of pain. Moving even the slightest distance will feel like a Herculean effort – but your doctor will provide pain relief, which will usually either be via catheter if you had an epidural, or injections if you had a general anaesthetic. Make sure you talk to her if you’re still feeling uncomfortable. You will get the same bleeding from the uterus as if you had had a vaginal delivery, and wearing pants that are one size bigger is a good idea so your wound isn’t confined too tightly. Coughing and laughing will hurt but if you hug a pillow against your abdomen to support the area, this should make it slightly more bearable. Finally, sorry ladies, but trapped wind can also be an issue. Try tightening your tummy when you breathe out, and ask for some peppermint water.
Some women will simply be over the moon that they have a healthy baby, but if you’re left feeling deflated, don’t worry: it’s perfectly normal to be left in shock or even to feel as if you’ve suffered a loss, particularly if the Caesarean was not through choice or was conducted in an emergency situation. Make sure you take the time to mourn this. Talk it through as many times as you need to with your husband or doctor.
It will be a little more difficult to breastfeed because usually you’d hold your baby against your torso, which will now be very sore. First, lie back and get yourself comfortable, and then get whoever’s with you to pass you the baby and position him wherever works for you – many people find tucking the baby’s legs under their arm works well. Don’t strain towards him as you can injure your back or neck; guide him towards you instead.
After the initial time in hospital (around three days), there is still a long road to recovery – sometimes as much as a year. Most women are told not to drive for at least six weeks, and lifting heavy objects is out of the question. Alas, toddlers are included in this, so make sure you have plenty of assistance close by. The day after the op, a physio will teach you some gentle exercises to start with, and you can increase the intensity about six weeks later, after your postnatal checkup. The good news is that most women can go on to have vaginal deliveries if they wish, and the scar is usually a small bikini line mark which fades with time.
A matter of choice?
We spoke to two mums who’ve been there, undergone the op and got the scar – albeit for very different reasons.
Jean Tipton, 44
‘At the age of 41, I became pregnant with my third child – my other two were 21 and 23 years old. It was quite a surprise, to say the least. The doctors said I was healthy enough to go through with a natural birth, but I decided to have a Caesarean. I had already delivered naturally, drug-free and all, twice – the second time to a baby weighing an extremely painful nine pounds and five ounces – so I knew what it was like to feel like I’d been whacked repeatedly between the legs with a baseball bat. I had nothing to prove and I thought at my stage in life, I had more than earned the right to choose.
Because my husband was travelling a lot with work at the time, we booked the surgery for a day when he would be able to be there. Opting for a C-section instead of a natural birth turned out to be a fortuitous decision: again, it was a very big baby, and he managed to turn himself upside-down during the delivery. Not quite the simple 10-minute procedure I had hoped for, but I was pretty glad I didn’t have to push him out the old-fashioned way!’
Cerise Callaghan, 31
‘Three days after my 35-week scan, which had shown my baby was breech, I started bleeding. The doctor dismissed it at first but he put me on a contraction-checking machine to be sure. Five minutes later, I had a massive one and was told the baby was on its way. Later, the nurse said she couldn’t see the baby very strongly on the monitor and next thing I knew, I was being wheeled into the operating theatre. You imagine childbirth to be a process where people are holding your hand, saying it’ll be OK, but it was more like, ‘Suction please nurse.’ It was so clinical and it felt like I wasn’t involved. It all happened so quickly, it was like I was pregnant one minute, a mother the next – there was no middle bit.
Because my baby had fluid on his lungs, he was taken to the neonatal intensive care unit and I wasn’t even able to see him for the first 24 hours. That just added to my feeling that I had missed out on something.
I would never choose to have a Caesarean – it was very hard lifting him while I was recovering, and I couldn’t drive for six weeks. It was painful and a lot of after care was involved; I was forever going to the hospital to get stitches checked and the scar, while hidden, is pretty big.’