The Caesarean Section Method - Essay Example

Running Head: CAESAREAN SECTION IN DEVELOPED AND DEVELOPING COUNTRIES Introduction The discovery of the Caesarean Section method of childbirth is a blessing to women who experience extra difficulty in giving birth the natural way. The CS procedure offers them, as well as to their babies, greater safety in delivery. The growing penchant for CS, however, had alarmed the WHO a few decades back noting the increasing and unjustifiable rise of childbirth through this artificial method. The Organization issued a statement against the increasing CS rates in the hope of encouraging women back to the traditional method of giving birth. It seems, however, that the WHO’s declaration fell on deaf ears because today the statistics on CS rates are far beyond what it envisioned. The phenomenal increase in childbirths through the CS, particularly in developed countries, is indeed alarming considering that various studies have associated CS with maternal and perinatal mortality and morbidity. In stark contrast with CS statistics in developed countries are statistics in least developing countries showing extremely low CS rates. The implication of the latter is that pregnant women in those countries are also potentially at risk because the CS procedure seems to be unavailable to women who are actually in need of it. Background: Caesarean Section Procedure CS is a procedure in childbirth in which the baby is delivered through an incision in the abdominal wall rather than through the vaginal opening of the mother. Normally, this procedure is employed when the natural method of giving birth poses danger to the life of the baby, but there are indications pointing that it is also being used other than for medical reasons. The CS procedure may be performed either through the lower segment section or the classical caesarian section. In the former, the incision is made below the navel, whether as a midline subumbilical abdominal incision or a transverse suprapubic incision. On the other hand, the latter entails a longitudinal incision in the superior intrauterine section (Hanretty 2009, pp. 315-316). From a medical perspective, the indications for C-section procedure include, among others, dystocia, fetal distress, cephalopelvic disproportion, breech presentation, repeat caesarean and vaginal birth after caesarean or VBAC, placenta praevia and maternal diabetes. Dystocia is the general term used to refer to labor-related complications that may come in the form of extended labor or fetal position. It is considered as the number one reason for CS in the 1990s, which resulted in the recommendation of the National Institute of Health to examine this diagnostic indication more thoroughly. Fetal distress, on the other hand, refers to life-threatening condition of the baby during labor often manifested by its diminishing movement, irregular heartbeat and the passage of its bowel content into the amniotic fluid, among others. Fetal distress is also one of the top medical reasons for resorting to CS. In cephalopelvic disproportion, a cesarean section is conducted because delivery through the normal method is difficult because of the disproportion between the size of the pelvis and the baby while breech presentation refers to the abnormal position of the baby in the womb of the mother, which would necessitate the difficult delivery of having the baby’s feet come out first (Churchill 2009). Non-medical variables as underpinnings of births by CS have also been accounted for in the rise of the use of the procedure, especially in developed countries. Ghosh & James (2010) stated that the fact that high rates of CS rates observable in affluent groups and private hospitals are tell-tale signs of forces, other than medical, at play in decisions to resort to CS (22). These non-medical variables include the following: declining birth rate, which is said to urge consultants to aspire for better fetal outcomes through the employment of caesarean section; hospitalization, which would more likely result in an interventionist style of birth delivery; the midwives and obstetrician dichotomy, with the latter more likely to recommend delivery by CSn than the former; technological management of labor; anxiety and fear of litigation; age of mother; changes in diagnostic practices and procedures; electronic fetal monitoring; preference of individual consultants; gender of the physicians (Churchill 2009, pp. 70-83; Khan 2008, 1; Lauer et al 2010). Caesarean Section Rates in Developed and Developing Countries Bertran et al made a study of CS rates from the national, regional and global perspectives. Published in 2008, the study made use of surveys of CS deliveries in several countries, associating these rates with mortality of mothers, infants, and the unborn before, during and immediately after delivery. These surveys were conducted by the Demographic and Health Surveys in 53 developing countries (Bertran et al 2007, pp. 1-17). Stanton et al, (2005) however, asserted that DHS CS statistics that are extremely low are not so accurate (p. 453). For European countries, data from European Health for All Database and for the rest of developed countries, published vital statistics were employed to estimate CS deliveries. For 39 other countries, most of which are developing, that did not have data available as the aforementioned, the group used other methods such as electronic data from government web sites and other related sites. Collectively, all data gathered represented 89% of global live deliveries from 126 countries. The group established that 15% of birth deliveries are made through CS, with 21% in developed countries, 14% in less developed countries and a meager 2% in least developed ones. Table 1 summarizes the findings detailing the regions and the percentage of their respective CS vis-à-vis the world rate (Bertran et al 2007, pp. 1-17). Although collectively, developed countries in various regions of the world had a CS rate deemed highest than those of less developed and least developed countries, the Latin American and the Caribbean region had, in fact, the highest CS rate on a per region basis at 29.2%. Table 1 CS Rates by Region, 2005 (Bertran et al, 2007, p. 17) The aforesaid finding comes two decades after the World Health Organization had already censured the 10-15% CS childbirth delivery rate in the world with the much quoted statement that “There is no justification for any region to have caesarean section rates higher than 10-15%” (quoted Bertran et al 2007, p. 31). Today, women are four times more likely to opt for CS than three decades ago (Karanth & Satish 2010, p. 197). According to an OECD data in 2003, the 16 countries with the highest number of CS childbirths are: Italy; Australia; US; Germany; Canada; Ireland; New Zealand; Austria; France; UK; Belgium; Finland; Denmark; Sweden; Norway; Netherlands. All 16 countries are considered developed countries (Health Statistics 2003). In the 2007 statistics, the US reflected an unprecedented 32% rate in CS childbirths, the highest ever reported in its history. That is about 1.4 million CS births, representing a 54% change from the 1996 statistics. The states with the highest CS childbirths are Florida (37.2%), Mississippi (36.2%), Louisiana (35.9%), West Virginia (35.2%), Arkansas (34.8%) and Kentucky (34.6%). The highest percent changes are the states of Rhode Island, from 17.7 in 1996 to 32.2 in 2007, Connecticut, from 19.8% in 1996 to 34.6% in 2007 and Nevada, from 19.3% in 1996 to 33.1 in 2007 (Menacker & Hamilton 2010, p. 5). Other countries are showing the same phenomenal rise in CS rates. China, for one, is reported to have increasing numbers of childbirth deliveries by CS with purportedly 46% of its pregnant women undergoing the procedure. CS procedures were originally justified to lessen mother and child risks during childbirth, but today, reports abound that CS procedures are being conducted and requested for reasons other than concerns for maternal and child health. CS is now being perceived as a more convenient way of giving birth. In Asia, some reportedly request for CS so that their children can be born on a lucky day. In China, where the procedure is fast-rising, a CS method of delivery signifies status and wealth. It also aligns with the country’s cultural values on childbirth where control, to keep the population down, is emphasized. This procedure is likewise beneficial to the doctor because it is less time consuming than having women undergo labor, which, in some cases, can take for days. In the US, doctors prefer this method of delivery because it ensures them from malpractice suits relative to the use of high-tech delivery methods (Stange et al 2011, p. 269). Fig. 1 Top Countries with CS Childbirth Cesarean Sections and Maternal and Perinatal Health Nonetheless, a CS procedure exposes mother and child to greater risks than vaginal delivery. The procedure entails exposure to complications, thus, increasing the period of hospitalization. Undergoing CS during childbirth is said to increase risk of mortality for mothers up to 10 to 20 times higher than those who deliver their babies normally. Similarly, new born babies through CS usually spend more time in neonatal intensive care to allow the mothers easier recovery (Stange et al 2011, p. 269). In a study conducted by the HRP, it was established that a high CS ratio is associated with severe maternal morbidity and mortality as well as higher fetal mortality rates and neonatal morbidity and mortality. Supported by data collected in eight countries, the HRP study would tend to point to the notion that high CS rates do not equate to better perinatal results. Moreover, this study links high CS rates to maternal, infant and perinatal mortality in countries with low mortality (Localizado 2008, p.16). CS is a major surgery and is invasive. Specific forms of maternal morbidity associated with high CS rates are febrile morbidity at 24-27%, blood loss at 4-8%, urinary tract infection at 3%, wound dehiscence at 0-10%, while post partum depression related to CS is also noted to be rising (Goldman & Hatch 184). Other risks include anemia and possible blood transfusion, injury to other organs like the bowel and the bladder, blood clots and anesthesia complications. Giving birth via CS places the mother four times at risk for death than vaginal delivery. Moreover, a CS also affects the baby and may subject it to risks that are not present in vaginal delivery. These risks may include preterm birth due to inaccuracy in the date assessment, respiratory distress syndrome, which can easily lead to its death, delayed bonding between mother and child, as well as delayed breast feeding (Kawasaki pp. 7-8). Conclusion The CS is an innovation that has helped at-risk pregnant women in childbirth. Childbirths that were once considered dangerous and were emergency cases, have been rendered less so with the discovery of this method of delivering babies. Nonetheless, the phenomenal rise of the use of procedure in developed countries is alarming. From being a tool for life-saving, the CS is now use for the convenience of the mother and worse, of the hospitals and doctors. Pregnant women are now shunning the normal and natural way of giving birth for this invasive, riskier, artificial and more expensive way of giving birth to please themselves, their doctors and the hospitals. Somehow, the myth that giving birth through CS is safer in all cases has been perpetuated by doctors which are now more reliant on high technology than their skills or are more in a hurry to get things done fast than getting things done right. Yet, studies have shown that CS delivery is actually riskier to mother and child than giving birth vaginally as shown by various surveys. This does not diminish, however, the importance of CS where delivery by natural method is already established to be dangerous to mother and child. The CS procedure should remain to be employed where it should be employed: in real childbirth emergencies. On the other side of the coin, the CS rates for the least developed countries are likewise thought-provoking. At 2%, this CS rate is a long way from the WHO recommendation of 15%. Most likely, the implication of this statistics is that pregnant women in these countries do not have the same kind of accessibility to doctors, hospitals and technology that would allow a CS procedure when the same is needed because of true emergency reasons. Unlike their counterparts in developed countries who have the benefit to opt for CS with or without real medical emergency, women whose lives are clearly at stake because of potential difficulties in natural childbirths may not even have the financial wherewithal to undergo a CS procedure even if doctors and hospitals are available. Mary Lou Moore (2005) believes that reeducation is needed to teach, and re-teach, the culture of childbirth as well as the fact that CS delivery is artificial and unnecessary for women whose lives are not at risk in natural childbirth method. She believes that the present rise of CS in developed countries is a matter of culture clash – a clash that can be remedied by correct education. References: Bertran, A., Merialdi, M., Lauer, J., Bing-shun, W., Thomas, J., Van Look, P., & Wagner, M. (2007). ‘Rates of Caesarean Section: Analysis of Global, Regional and National Estimates.’ Paediatric and Perinatal Epidemiology, Vol. 21: 98-113. http://www.rabn.org/pdf/CsectionRates.pdf. Churchill, H. (1997). Caesarean Birth: Experience, Practice, and History. US: Elsevier Health Sciences. Ghosh, S. & James, K.S. (2010). ‘Levels and Trends in Caesarean Births: Cause for Concern?’ Economic & Political Weekly, Vol. 15(5). Goldman, M. & Hatch, M. (2000). Women and Health. Florida: Gulf Professional Publishing. Hanretty, K. (2009). Obstetrics Illustrated. US: Churchill-Livingston. Health Statistics: Births by Caesarean Section by Country. NationalMaster.com. http://www.nationmaster.com/red/pie/hea_bir_by_cae_sec-health-births-by-caesarean-section. Karanth, K. & Sathish N. (2010). ‘Review of Advantages of Joel-Cohen Surgical Abdominal Incision in Caesarean Section: A Basic Science Perspective.’ Med J Malaysia, Vol 65(3): 197-201). Kawasaki, M.P. (2005). Mothering with Breastfeeding and Maternal Care. USA: iUniverse. Khan, H. (2008) High Caesarean Section Rate: Can We Reduce It? Gomal Journal of Medical Sciences, Vol. 6(1). Lauer, J., Betran, A., Merialdi, M. and Wojdyla, D. (2010). Determinants of Caesarean Section Rates in Developed Countries: Supply, Demand and Opportunities for Control. World Health Organization. http://www.who.int/healthsystems/topics/financing/healthreport/29DeterminantsC-section.pdf. Localizado, A. (2008) Sexual and Reproductive Health: Research and Action in Support of the Millennium Development Goals: Report 2006-2007. Switzerland: World Health Organization. Moore, M.L. (2005) ‘Increasing Caesarean Births: A Clash of Cultures?’ Journal of Perinatal Education, Vol. 14(4): 5-8. Menacker, F. & Hamilton, B.E. (2010) Recent Trends in Cesarean Delivery in the United States. NCHS Data Brief. Stange, M. Z. & Oyster, C. & Sloan, J. (2011). Encyclopedia of Women in Todays World. US: SAGE. Stanton, C., Dubourg, D., de Brouwere, V., Pujades, M., & Ronsmans, C. (2005). ‘Reliability of Data on Caesarean Sections in Developing Countries.’ Bulletin of the World Health Organization 83: 449-455. http://www.who.int/bulletin/volumes/83/6/449.pdf. Read More