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    Why more women are going the cesarean section way –

    Comfort Oluwaseyi is a first-time mum who had planned how she would give birth to her baby. It was already an 8-month journey and had been a very easy period until she had to have a baby earlier than expected.

    It was on a routine check-up and the doctor noticed that her baby wasn’t doing well at that time. He told her to do some further scans and just a verification to know exactly what the issue was and because of that she also developed high blood pressure which could lead to preeclampsia.

    With that conspicuous sign, the doctor recommended her admission and made the cesarean section (CS) call after the examination. Induction or a normal delivery was decided to be risky as the baby would have been in more distress.

    “At 7: 00 am I was taken to the theatre and after about three hours I was out,” she said. Oluwaseyi had decided to have an elective cesarean section (CS) as she already planned she wasn’t going to deliver through virginal birth.

    “I don’t think I can stand the stress of pushing. That would be too much,” she said, adding that she would still go for C-section any time because she was not sure that she can do virginal birth because she already feels traumatised even without experiencing it.

    “I would always opt for C- section. Giving birth through C-section is not a death sentence, it’s a choice,” she said.

    Bolu Essien, who is also a first-time mum, had planned how she would give birth to her baby. A contradictory moment came, it was found that the baby’s cord is tied three times to his neck; it was an emergency to avoid the baby from strangling.
    After hearing the news, Bolu called her husband in order to sign the consent form. He quickly agreed to sign the consent for the C-section procedure.

    According to her, “My pain was forgotten as I was happy to see my son. I never planned to push or to have a virginal birth coupled with my baby’s condition. My husband signed, as he saw an emergency, C-section was the only option to save my life and that of our baby.”

    Meanwhile, at 39 weeks of pregnancy, one of the guests at the Scars of honour trailer documentary unveiling shared her traumatic experience. According to her, she had high blood pressure and “because of the preeclampsia, I couldn’t sleep.”

    Her case was very severe as her blood pressure read 220/130. According to her, as the doctors and midwives were getting her ready for surgery, they were also monitoring to check on the child to see if the baby was doing well too.

    “They checked my baby like 10 times to be sure the baby was beating. When they checked they couldn’t find the heartbeat of my child. I was looking at them and I was so tense. The doctor was just trying everything for like 20 minutes getting this. And then he had a little heartbeat. Immediately they started the procedure.

    “I was pierced about 30 times for over one hour, I was freaking out but I couldn’t cry out because all I wanted was just to have myself and my baby alive. I forgot the fact that I had serious BP. I know it was a 50/50 thing; it was a matter of life and death.

    “It was a traumatic experience. I had my baby boy and I was very happy. If I had known and now that I am aware, if am to give birth again, I would opt for an elective C-section. Even though my first experience was an emergency, I still would not want a vaginal birth again. This is because, with a C-section, I know what to expect,” she said.

    However, the experience of Oluwaseyi, Bolu, and another are just three stories out of thousands of stories of Nigerian women who are going the C-section way to give birth. According to a 5-year survey of cesarean delivery at a Nigeria tertiary hospital in 2018, the majority of babies, about 79.9 percent, were delivered through emergency means.

    “A woman’s age affects her decision to opt for C-section with women between the age of 35-40 accounting for 11.2 percent of the total C-section birth and women between the age of 25-35 accounting for 7.5 percent of a total C-section birth,” according to the prevalence of cesarean sections in Enugu, South East Nigeria analysis of data from the Health Beginning Initiative, 2017.

    Creating awareness

    A Bolu Essien documentary “Scars of Honour … cesarean section, a sacrifice of love” shows women giving birth through C-section, saving mothers’ and babies’ lives; it is doubtlessly a safe alternative to a vaginal birth in case of an emergency.

    According to Essien, director, and producer of the documentary says it shows how more women are embracing elective C-sections. “We want to break the stigmatisation and increase awareness of delivery options. This is the very reason we did the documentary.

    “Data show about 13percent of women will reject C-section despite that it isnecessary, but in a bid to reduce the number of mortalities, the scars of honour trailer was released on the 31st of March and it’s getting reactions; people from different countries already tagging.

    Specialists say there are more than chances to save lives in numbers through elective C-sections.

    “This C- section is one of the most fundamental and important surgical interventions in obstetric care. And it should be available, where it’s needed when it’s needed, and the woman should also be highly prioritised. It’s not something you do for everybody. It has to be indicated and it must be done with experience to avoid morbidity and mortality to the mother and also to the baby,” Lateef Akinola, a consultant-obstetrician and gynaecologist at Medison Specialist Hospital.

    According to the Gynaecologist, C- section varies across the world. “In Nigeria, it is about 2.1percent clearly showing that we have a lot of unmet needs when it comes to C- section availability for Nigerian women compared to the United States where it’s close to 30percent Europe is about 20percent and even in South America is close to 50percent. So, you can see the difference between 2.1percent and roughly 50percent.”

    There are a number of risk factors that can make one undergo a C-section. Some factors include prolonged labour, breech presentation at term, primary genital herpes, fetal distress, pelvis retraction, birth defects, repeat cesarean, cord prolapse non-reassuring fetal status, and transmissible diseases.

    “The condition that surrounds this, some people think cesarean delivery as a weakness to be a part of the woman. Some see C-section as no valid indication about section because if you tell a woman that she needs a C section for delivery, they will see it as if the medical doctor wants the financial benefit out of it,” says a Lagos-based Okey Ugwu, a consultant-obstetrician and gynaecologist.

    The specialist further explained that before you take any woman to the theatre for any surgery at all, you must have explained the procedure, the risk-benefit ratio.

    Read also: World Health Day: Stakeholders urge Nigeria to improve on medical emergency response

    “We still have a lot of unmet needs, in terms of the infrastructure, technology, the dichotomy of care between our villages and the cities. In this part of the country, a lot of women are still patronising traditional birth attendants,” he said.

    “C-section is what every woman should accept when recommended. It doesn’t reduce your tickets as a woman. More women need to be aware of C-sections and educated to the extent that they can sign the content form because sometimes there’ll be a valid indication for a Caesarean section. They won’t sign especially in our environments. What if the husband is going out of town?

    “This woman needs support because they are going to be in post-operative pain. I advise religious bodies to get the women incorporated into marriage counseling and advocate C-section options because a lot of first-time mum have little or no knowledge of complication at delivery,” Ugwu said.

    Health Insurance companies have also observed an increase in the number of C-sections. Speaking at the documentary unveiling, Tope Adeniyi, chief executive officer of AXA Mansard Health, said we must increase awareness of delivery options to our women in Nigeria. We won’t make ignorance continue to prevail, both from a cultural point of view, a traditional point of view, and a religious point of view, despite our education.

    “CS deliveries range between N150,000 and N200, 000 while normal birth is about N25,000 to N50,000,” Adeniyi said.

    According to Adeniyi, at AXA Mansard, the payment issue is not an issue once you have a plan that covers it. Our desire is to say all women in Nigeria are uncovered, even if it is basic health care coverage as low as possible. Get on any healthcare that we plan. Most of our healthcare covers delivery for women.

    “Women are very important and we are here to support women’s delivery. AXA, we keep standing for what is good to empower people to live better lives to stand for what continually improves productivity for people, productivity for women and the entire nation,” he said.

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