Is caesarean a troubling trend?

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The joy of any newly-pregnant couple is always tempered with the trepidation of the process of labour and delivery. This is more keenly felt by the wife who has to undergo the physical challenges that come with childbirth.

Parents who are having their second or third child are a bit more prepared, but depending on what they went through the first time around, may be more inclined to have a natural vaginal delivery or a caesarean delivery, or LSCS (Lower Segment Caesarean Section) as it is commonly referred to in Malaysia.

This fear is probably one of the main reasons for the increase in the number of caesarean sections globally. In Malaysia, about 15% of all deliveries were caesareans in 2000 and that percentage increased to 30% in 2016. More and more parents are opting for an elective procedure due to a fear of pain or any harm befalling their baby during the delivery process. In private practice, the doctors are more than willing to acquiesce to their demands.

So the question is, as more medical options become available to us, what is the best way to deliver a baby? There is no correct answer.

Every pregnancy and subsequent delivery needs to be individualised. There are certain situations when a caesarean is mandatory and this will be pointed out by your obstetrician. They can include things like a placenta praevia or low lying placenta which precludes a patient from having a normal vaginal delivery.

The real decision lies in the hands of patients who have no medical need for a caesarean. Do these parents now opt for a c-section or attempt natural childbirth?

Let’s tackle the main issue that usually defines this particular question. Pain or the fear of pain during labour remains the number one reason for couples to choose to have the surgery when there are no other obstetric indications.

Medical school teaches us that pain during childbirth is the most severe pain a person can feel for a biological cause. This information is now freely available on websites and magazines thus increasing the fear factor in potential parents.

Pain is far more easily manageable now with the advent of epidurals though. These are analgesics applied directly into the patient’s back and spinal cord that reduce pain by up to 70%. The side effects are minimal and more and more women are having pain-free vaginal deliveries or at least, if not pain free, with a significant reduction in pain. Make sure you check with your delivery centre if these are available if you are keen to take that route.

There are those who think having a caesarean reduces the risks faced by the baby. This is true and has multiple studies to back it up. Babies delivered via c-section, despite having a slight increase in needing some oxygen initially, have far less morbidity. There are far fewer cases of babies dying or suffering from trauma related to the surgery as opposed to a vaginal delivery. That is not to say that vaginal deliveries are unsafe, far from it, they just suffer by comparison.

However, undergoing a caesarean does increase the possibility of injury to the mother and there are complications like bleeding, infections and a longer delivery time. This is the reason why a balance must be struck and not all deliveries must end with a scalpel.

The take-home message for all newly-pregnant couples is, there is no right or wrong way to deliver a baby. As individuals you neither have to listen to advocates of a normal delivery with no drugs whatsoever, nor doctors who insist on abdominal deliveries. You have the freedom to individualise your experience to ensure the best outcome based on your preferences.

I cannot overstate the importance of developing a rapport and communicating with your doctor. This is the only way you can make an informed decision. The Internet and various other “specialists” are far from ideal to obtain information for a medical-based decision.

Your baby is a product of your love and devotion, and you would have spent the better part of nine months carrying him or her. Hence, you should ensure there are no slip ups in the final furlong.

Dr Pravin Peraba is an avid writer masquerading occasionally as an Obstetric & Gynaecology consultant while crossing things off his bucket list.