Newborn babies: Doctors differ on caesarean sections

.WHO laments increase, say 140 million babies born annually

The World Health Organisation (WHO) has expressed concern over the increasing medicalisation of normal childbirth processes.

The global health body said this was undermining a woman’s own capability to give birth and also negatively impacting her birth experience.

According to WHO, about 140 million births take place every year globally and most of these occur without complications for women and their babies.

This was made known by Nothemba Simelela, WHO’s Assistant Director-General for Family, Women, Children and Adolescents, while issuing new guidelines on global care standards throughout labour period and immediately after childbirth.

The official said the new guidelines is aimed at reducing the use of needless and potentially harmful routine clinical and medical interventions.

He said: “We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities”.

But according to the world health body, over the past 20 years, health practitioners have increased the use of interventions that were previously only used to avoid risks or treat complications, such as oxytocin infusion to speed up labour or caesarean sections.

Reacting to the report, a Professor of Obstetrics and Gynaecology, Prof. Innocent Ujah, said a lot of factors acount for caesarean sections to reduce the risk of death of a woman dying during childbirth.

Ujah, who is a former Directoral-General, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, said though some patients request for caesarean sections to avoid going through the pains of labour, no doctor will book a pregnant woman for CS when she can deliver on her own.

Givining reasons on why caesarean sections were high in developing countries like Nigeria, the Consultant Obstetrician and Gynaecological Surgeon, said: “Well, l look at fetal and maternal indications before thinking about caesarean sections.

“We are careful about CS. If there are no danger, CS is not necessary. But if the baby is big and the pelvic of the woman is narrow, to avoid rapturing the uterus, the woman will be booked for a caesarean section to save her life and that of her baby.”

Blaming the high rate of maternal mortality in Nigeria on activities of quacks and cultural practices, Ujah said: “When we carry out caesarean sections when necessary, we reduce the risk of death and complications from childbirth.

“It is important to note that after two caesarean sections, the rest of the deliveries for that woman will be through caesarean sections”, he added.

Studies show that a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth.

Chairman, Association for Advancement of Family Planning (AAFP), Dr. Ejike Orji, said teenage pregnancy and child marriage were increasing the cases of caesarean sections in Nigeria.

Orji said the number of women suffering from Vesico Vagina Fistula (VVF) in the country was becsuse they lacked access to caesarean sections, stressing that CS was necessary to save the lives of women with complications during childbirth.

He, however, noted that some private hospitals exploit some pregnant women by booking them for CS when not necessary in order to make money.

On his part, National President, Nigerian Medical Association (NMA), Prof. Mike Ogirima, called for standardisation in surgical practice in order to stop the activities of quacks in the system.

He blamed the increase in CS on activties of quacks.

Contiuing, Simelela added: “If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour.”

From the 56 evidence-based recommendations, the new guidelines include having a companion of choice during labour and childbirth. It also include ensuring respectful care and good communication between women and health providers and maintaining privacy and confidentiality.

It further allowed women to make decisions about their pain management, labour and birth positions and natural urge to push, among others. It recognised that every labour and childbirth is unique and that the duration of the active first stage of labour varies from one woman to another.

The UN agency also noted that with more women giving birth in health facilities with skilled health professionals and timely referrals, adding that they deserved better quality of care. Estimates show that about 830 women die from pregnancy- or childbirth-related complications around the world every day – the majority of which can be prevented with high-quality care.

“Achieving the best possible physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which health systems empower all women to access care that focuses on the mother and child,” he stated.