Why you might need a C-section

South Africa has one of the highest rates of C-sections in the world, with two in three mothers in private hospitals giving birth via C-Section. Researchers believe that this is mainly because C-sections have become elective procedures based on convenience instead of medical necessity – especially in the private sector. This alarming trend towards having an elective C-section means that healthy pregnant women who would otherwise be able to have a vaginal birth are choosing to have a C-section because it’s the “new norm”.

Why women opt for this?

Obstetrician and gynaecologist Dr Zeelha Abdool says the reason why so many women choose to have an elective C-section is the convenience factor of planning and choosing when to meet their new baby. “For some mothers, having the delivery scheduled has considerable appeal, for many reasons. It eliminates the anxiety, stress and uncertainty of the onset and duration of labour, as well as the repeated vaginal examinations needed with a vaginal delivery. Most C-sections are performed under spinal anaesthetic, meaning the procedure is pain-free.”

When is a C-section “really” necessary?

Certified doula and midwife Magdeleen Moller says you should be prepared to go under the knife for the following reasons:

• If your baby is in distress

Only if there is a distinct problem and your baby is in distress will you need to have an emergency C-section. If the umbilical cord is near or close to your baby’s neck, Magdeleen says your gynae will first need to assess the risk and check the blood flow in the umbilical cord, as well as check your baby’s heart rate before proceeding with a C-section. Doctors advise that it’s always a good idea to monitor your baby’s movement and count the kicks as it will help you pick up any changes, especially in your third trimester According to the American Pregnancy Association, setting aside time every day when you know your baby is active to count kicks, swishes, rolls, and jabs may help identify potential problems and can help prevent stillbirth. Ideally, you want to feel at least 10 movements in two hours.

• If your baby is too big to pass through the vaginal canal

There are babies who may be large to be born via virginal birth. A big baby may weigh anything between 4kg and 4.5kg. It may be difficult for this baby to come naturally so doctors may suggest a C-section.

• Failure to progress during labour

This can cause your baby to go into distress and might put you at risk of further complications, too. If you are not dilating as you should or are over-due and inducing labour doesn’t work, then you can go under the knife.

• Unsuccessful turning or a breech baby

According to www.familydoctor.org, right before birth, most babies are in a headfirst position in the mother’s uterus. Sometimes, the baby is in a bottom-first (or feet-first) position. This is called a breech birth or breech baby. Babies can be breech early in pregnancy. Most of them turn on their own to be headfirst by the time of delivery. But if the by the time of birth, the baby doesn’t turn then a Caesar is necessary.

• If you’re pregnant with multiples

Your gynae might insist you have a C-section, even though it is possible to have a natural birth with twins. No doctor can force you to have a scheduled C-section if you’re having a healthy multiple pregnancy, says Magdeleen. But many gynaecologists don’t want to take the risk of delivering multiples naturally. There are also a few complications with multiple pregnancies that may give rise to having a C-section. These include:

• Preterm labour
• Low birth weight
• Gestational diabetes
• Placental abruption
• Intrauterine growth restriction (IUGR).

• Uterine rupture

Uterine rupture occurs most often along healed scar lines in women who have had prior Caesarean deliveries. This happens in less than 3% of mothers. To prevent uterine rapture your gynae will recommend a C-section

• You have an infection like genital herpes or HIV

To prevent the baby from coming into contact with virus in the birth canal, the safest delivery is via Caesarean section.

• Placenta issues

If your gynaecologist picks up that there are problems with your placenta, then a Caesarean section is deemed necessary and it would be an emergency and not a scheduled operation. Conditions like placenta previa, where the placenta is low lying, is a valid reason to have a C-section as this could be very dangerous during birth. Placenta calcification, where the placenta is maturing at a rapid rate, also needs to be checked regularly to ensure that it’s not compromising your baby’s growth and development. According to the American Pregnancy Association, placental abruption ,where the placenta separates from the uterine lining, is another issue that needs to be monitored carefully as it can disrupt the flow of oxygen and nutrients to your baby. If you’re experiencing any of these symptoms during pregnancy, you’ll need to see your healthcare provider immediately;

• Rapid contractions
• Vaginal bleeding
• Stomach pain
• Uterine tenderness