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C-section debate: Why the controversy will never go away

Health & Science
 C-Sections are primarily performed to save the life of the mother and her baby. [iStockphoto]

Last week, the streets of social media were lit on fire when a young man decided to post a comment that was perceived as discriminatory against women who had given birth through caesarean section. 

“Women who gave birth via caesarean section (C-section) do not know the pain of giving birth,” he wrote.

Shortly after he posted these words, women flocked his page to school him on the near-death experiences they had gone through during surgery, while others chose to ‘bring him up to speed’ using unprintable words.

Anti-caesarean section opinions aren’t a new phenomenon, over the years women who have given birth via C-section have often been accused of "choosing the easier way’’ to childbirth.

While the poster’s sentiments seemed to allude to the hotly debated issue of caesarean section upon maternal request, the controversy, in medical circles has always been around the balance of benefit vs harm between caesarean section and vaginal delivery.

While performing a caesarean section when it is not clinically indicated has traditionally been considered inappropriate, views may be changing as more people challenge the view that this procedure is clinically unjustifiable, even though the evidence on both sides is incomplete. 

While the World Health Organisation warns that unnecessary surgical procedures can be harmful to both a woman and her baby, it maintains that all health systems must ensure timely access for all women when needed.

“Caesarean sections are absolutely critical to saving lives in situations where vaginal deliveries would pose risks,” the Director of WHO’s Department of Sexual and Reproductive Health and Research announced in 2021.

It’s clear that the debate over the issue will never end as long as emergency surgeries continue to save lives and the definition of “medically necessary” remains in the attending doctor’s domain.

Medically necessary

Lucy Atim, the 33-year-old mother of a 3-year-old girl says it definitely was not the easy way because when the doctors made the decision to take her through the surgery, her life and that of her daughter were in danger.

“I thought I was going to push (deliver vaginally), and they even induced the labour but after labouring for a day and a half, the baby got stuck at five centimetres. My heartbeat and my daughters started dropping,” she says.

Twenty-two-year-old Tracy Kato has a similar story having laboured for a whole week. She went to the hospital when her labour pains started on Wednesday, March 8. After several trips to the hospital and back, Tracy says she was finally admitted to the hospital on Thursday, March 15 and induced the following morning. 

Tracy says that as she waited, she started questioning why she was still there yet she had started labouring a week before.

“It was difficult seeing women with their newborns while I am just there wondering, ‘Why me?’,” Tracy says.

“I waited until the following day when they induced the labour (to encourage stronger contractions),” she says.

  Tracy Kato, 22, laboured for a whole week. [File, Standard]

Eventually, they took her to the operating room, where she finally had her baby.

Tracy says that the experience was traumatic for her and anyone who says that a woman who has gone through C-section does not know the pain of giving birth has no idea what women go through.

According to Dr Saudah Farooquim, Consultant Obstetrician and Gynaecologist at Nairobi West Hospital, a C-Section is the delivery of a foetus through the abdominal wall and the uterine wall.

Dr Saudah says that C-Sections are primarily performed to save the life of the mother and her baby. Doctors make the decision after weighing the risks and finding that the baby is safer outside the mother’s womb.  

“Another indication would be breach indication where, for example, the breach of the baby is what will come out first. That one is risky for the baby again in the sense the umbilical cord can fold through or the head can get stuck. So we can get foetal death or the baby gets tired upon delivery, most of the time you will get a bad outcome,” she says.

Dr Saudah says another reason for a medically necessary C-Section is if the baby is too big and cannot be delivered vaginally as it would cause obstruction or if the mother is bleeding excessively.

Dr Saudah says that complications from the major surgery include bleeding or adhesions. Adhesions are when the body forms a band of scar tissue that joins two surfaces of the body that are usually separate. It can cause pain in future, or the organs in the body can attach to the uterus or to the abdominal wall and would make the next C-section or the next surgery a bit difficult. 

Should women go for C-Sections without an emergency?

Dr Saudah says that she would not recommend self-request C-Sections because of the risk of complications.

Also, a C-Section limits the number of babies you can have. The documented recommendation for the number of C-sections one can have is three C-Sections in a lifetime.

“The reason for that is when we make the incision on the uterus, it’s always going to be a weak point it does not matter how many years have passed because the uterine wall is made of muscle and when we cut through, it heals by fibrosis or it heals by scaring. That scaring will always be a bit weaker than the rest of the uterus, the more the C-Sections the weaker the area becomes,” says Dr Saudah.

However, Dr Saudah says that she has had patients who have had more surgeries and what a patient should follow is the doctor’s recommendation, especially the doctor who did the last C-Section because they know the strength of the uterus. If the uterine wall was too thin, then the experts might even recommend the woman should stop conceiving after two C-Sections.

She says that while, overall in the long term a vaginal birth heals faster than a C-Section, the recovery time varies from patient to patient. 

“After the C-section, the skin over the scar can heal after two weeks. Some patients heal even after seven days. It depends on whether you have diabetes that can delay healing or if you have low blood count,” she says.

 Dr Saudah Farooquim, Consultant Obstetrician and Gynaecologist at Nairobi West Hospital

In general, in about two weeks most of the wounds will close from the outside and, internally, the uterus can take around six weeks to three months to heal.

Bonding with baby

Dr Saudah says that there can be a little bit of a delay in bonding between the mother and the baby after a C-Section especially if it’s a complicated surgery or if the baby is not doing well; if the baby has come out with some respiratory distress.

However, Dr Saudah says that mothers who have had vaginal births can also take long to bond with their babies if there were complications.

She says that even in caesarean birth, skin-to-skin contact can happen very soon because nowadays patients receive spinal anaesthesia whereby the woman is paralysed from the umbilical cord downwards. 

“She’s able to hear, she’s able to see and touch her baby after birth,” Dr Saudah says.

Never easy

All factors considered, vaginal births should never be seen as a conquest of “real moms.”

From the risks and complications that can come from childbirth, it is clear that neither vaginal nor caesarean birth should be termed as “easy”. This school of thought is based on the misconception that caesarean delivery is less painful, safer, and healthier than vaginal delivery.

When the dust settles, the rates of maternal mortality remain unacceptably high. About 287,000 women died during and following pregnancy and childbirth in 2020 - that’s approximately 800 women dying daily from preventable causes related to pregnancy and childbirth, according to the WHO.v

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