…Dr Kyari confirmed that if such procedure was carried out without necessity by a medical practitioner, the patient is allowed to sue both doctor and hospital.
Reproduction is one of the characteristics of humans aside from movement, respiration, digestion, and adaptation. The importance of birthing the new generation cannot be overstated in Africa; in society a woman is not seen as a woman until she has produced an offspring of her own. What is even worse than this perception is the idea that vaginal birth is hailed as the only preferred method of producing a child. Thus, women who are unable to deliver vaginally are then viewed differently.
Of course, this position is backwards, unsensible, and stereotypical. The Fairview team in a bid to burst the myth surrounding caesarean section had an interview with Doctor Abubakar Kyari, a medical officer who has been practising for four years at the Yobe state specialist hospital, Damaturu. He shared insights into the medical procedure and how medicine has improved tremendously in that field.
Speaking on what caesarean section is, Dr Kyari described it as an operation that is performed through the abdomen and the purpose, for the delivery of the foetus. This surgery requires two incisions: the first incision is made through the abdominal wall, and then the second one is made through the uterine wall. According to him:
“Caesarean sections are done by doctors as an intervention based on an indication during pregnancy or labour. Indications are reasons why a medical intervention such as this operation is done on a particular patient.
“There are different classifications of indications of caesarean sections. We have the maternal-foetal indications, this means that the reason for performing the surgery is from both the mother and from the developed foetus ready to be delivered. There are also factors arising solely from the mother and it is known as maternal factors. Then there are indications arising from the baby which are known as foetal factors.”
Concerning the maternal-foetal indication, some of the reasons as to why caesarean section is advised for the mother during childbirth are: foetal-pelvic disproportion where the size of the mother’s pelvis is either abnormal or too narrow for the size of the baby to pass through as is the case with spontaneous vaginal delivery. Also if there is failure of progression of labour, less contraction or no contraction at all which is enough to expel the baby out, this is another indication from a pregnant woman.
Dr Kyari also mentioned that in maternal indications, cases such as eclampsia, pre-eclampsia and the placenta blocking the opening of the uterus, the mother would be advised to undergo the operation. If the mother has health conditions such as diabetes, or has cardiac diseases, she would be advised to undergo caesarean section. Also, if she has had previous uterine surgery i.e., given birth through operation, she would be evaluated to observe if she can undergo vaginal birth or advised to undergo the procedure.
For foetal indications, if the baby is observed to be in distress, if there is cord prolapse, cases of abnormal presentation of the foetus or abnormal placenta position will require caesarean section.
Moreover, there are two kinds of Caesarean section: the Emergency and the elective operation. Observations from the medical personnel would determine if there would be an emergency operation. In the same way, elective caesarean section happens when the mother has been evaluated and based on previous medical record, she decides a date for the child to be delivered through operation.
When asked if these medical procedures occur in Primary Health care centres, Dr Kyari said such procedures do not happen in those centres even though they are the closest facilities available to women. He mentioned that Primary health care centres are designed for preventive treatment and treatment of minor illnesses. However, few maternal and child health services like immunisation are carried out there. If there are cases of complications during delivery, the mother is referred to a general or specialist hospital. The availability of specialist hospitals in Nigeria and adequate facilities in general hospitals where people in rural communities have more access to becomes glaring; our health industry is lacking.
In cases where the mothers register for antenatal- observation of a pregnant woman from pregnancy till birth- services in Primary health care centres, they are evaluated and advised accordingly. In situations where they require a caesarean section, they are referred to specialist hospitals and arrangements are made because Primary Healthcare lacks the capacity to carry out extensive procedures in cases of complications.
As much as indications are required for recommendation of this procedure, some victims have come out to complain that Caesarean section was performed on them even though it wasn’t needed. Dr. Kyari acknowledged that such practices are unethical. He stated that, if they do occur among some practitioners, the motivation may be financial gain. However, he emphasized that no licensed practicing doctor would recommend a procedure without a legitimate medical indication. The convenience of scheduling birth as against the spontaneous and unpredictability of some women undergoing natural/vaginal birth also makes some obstetricians recommend the procedure based on the woman’s medical history and her consent.
All medical officials are required to provide full patient autonomy by providing full and unbiased information to the patients concerning their health. This is one of the ethical considerations for all doctors. Doctors are not to harm their patients in cases of interventions. As the operation carries risk factors such as infections, longer recovery rate, likely complications, and complications in future pregnancy, the risk factors should be explained to the patient. As such complications can arise, it is important this procedure is carried out only when necessary and not because of personal benefits to the hospital.
Also, undermining informed consent occurs when medical practitioners recommend caesarean section even when it is not necessary. Doctors live by the directive that they should do no harm to their patients. So, interventions should not affect the patient. Recommendations should only be for the best interest of the patient. As performing such procedures without need will lead to wastage of resources, more expenses and might give rise to lactation complications, it is best that the operation is carried out based on necessity.
Due to the risk factors associated with performing Caesarean section, Dr Kyari confirmed that if such procedure was carried out without necessity by a medical practitioner, the patient is allowed to sue both doctor and hospital. According to him “Healthcare providers owe their patients first and foremost, a duty of care”. Breaching this duty can cause harm to the patient. Without clear reasons for such actions, and receiving informed or written consent, the patient can sue the hospital.
In the past, people were rightly scared of caesarean section due to its cumbersome nature; patients suffered from huge scars, abdominal pain, and even cases of medical items being forgotten inside the body during surgery. This made people avoid the procedure even when necessary and earned it a negative stereotype. However, medicine has improved in rendering this service. Technological developments have reduced these challenges to a significant rate. According to Dr Kyari, there are more qualified practitioners, advanced research and practices have been developed. The availability of technology coupled with the level of expertise of the practitioners have alleviated these challenges.
“The capacity of healthcare workers is better now compared to years back. Training, research, and resources available now compared to the past have completely reduced the previous challenges faced with Caesarean section. Availability of more hands have helped medical practitioners presently compared to the past where only one doctor is available to handle patients all through the month. Even the surgical practices are different now. The techniques have been developed so that even scars from the operation are neat and almost invisible.”
On the issue of the stories concocted around Caesarean section with myths about how such patients will end up with fewer number of children; children being more susceptible to bad behaviours; children not developing like others, Dr Kyari explained more on the topic.
He said “there is a certain number of caesarean sections that a woman can undergo after which she is counselled to undergo a certain procedure that would limit her child delivery. If continuous operations are carried out on a woman, especially when little intervals happen between each section, it is harmful. Unlike normal vaginal birth where a woman can deliver about 12-15 children successfully, it is unlikely for 15 caesarean sections to be carried out on a woman. A younger woman can have more caesarean sections than an older woman because the older woman is closer to the age of menopause. Also, procedures or indications from the previous operation will determine if the woman can have more operations carried out on her.”
“Considering the behaviour of a child, there are a lot of factors that affect a child’s growth and behaviour such as genetic factors, environmental factors, food available, nature of parenting, education received all affects the development of a child. However, there is no scientific evidence that caesarean section prevents a child from growing and developing like other children birthed through spontaneous vaginal birth. So that is a myth.”
Dr Kyari also discussed the various efforts medical practitioners are undergoing to allay the fears of individuals towards CS. He said fear mostly occurs when a patient doesn’t know what will happen to her during the procedure. To allay fears, doctors try to reassure, counsel, educate and capitalise on their expertise and knowledge to ensure the patient is aware of the procedure and the risks involved.
Experiences of people in the past on Caesarean section have forced most to create a negative perception of the procedure. Coupled with the costs involved, most would prefer a spontaneous vaginal birth irrespective of the complications and effects to both mother and child. However, technological advancement has helped doctors in the area of Caesarean section through procedures, skills, knowledge, and research. It is important to always listen to the advice of the medical practitioners before, during and after labour, seeking second opinion when not convinced is allowed, the opinions of medical professionals are vital and can be key to survival of mother and child.
